Application of Reverse Anterolateral Thigh Flap in Infected Knee Defect Reconstruction in a Pediatric Patient with Developmental Disability

Abstract

Development of the microsurgical technique and knowledge of vascular anatomy has led to a high success rate and good results in pediatric free flap reconstruction. However, in free flap reconstruction in pediatric patients, there is difficulty in flap dissection and vessel anastomosis because of the small size of the vessels and the tendency of vasospasm.1,2 In addition, in uncooperative patients with mental and developmental disability, disastrous results can occur postoperatively. Reconstruction of the soft tissue defect of the knee remains difficult and challenging and becomes even more difficult in defects accompanied by infection. This is because local available tissues are often unhealthy and not sufficient to cover the large defect.3,4 Some reconstructive options have been introduced so far, including localmuscleflap, reverse anterolateral thigh (ALT) flap, and free flap. In the free flap, major vessels are usually located deeply, requiring meticulous and tedious dissection which can result in injury to major vessel and requiring a long operation time.3,5,6 Also, with a local muscle flap, there is relevant donor-site morbidity including contour deformity.3 ALT flap, one of the most popular flaps, has been used as a pedicled or free flap with a wide variety of clinical applications.5–8 Despite some reports on efficacy of reconstruction using ALT free flap in pediatric foot and ankle defects,2 few cases of reverse ALT flaps successfully transferred for reconstruction of soft tissue defects of the knee have been reported. Therefore, we reconstructed an infected soft tissue knee defect in a pediatric patient, who had no cooperation capability due to mental and developmental disability, using reverse ALT flap and report the case. Case