Reconstruction of wide soft tissue defects with extended anterolateral thigh perforator flap turbocharged technique with anteromedial thigh perforator.

Abstract

The necrotic change may sometimes occur in peripheral parts of the flap when harvesting a wide flap in a patient with a relatively thin thigh in anterolateral thigh (ALT) flap. Here, we explore the prophylactic measure of turbocharging the ALT flap with anteromedial thigh (AMT) perforator based on the circumference of the patient's thigh to reduce the risk of partial flap necrosis for the reconstruction of wide defects. From January 2015 to December 2017, extended ALT perforator turbocharged flaps were done in nine patients. The majority of patients had post oncological or traumatic defects of upper & lower extremities and groin. The age group ranged from 22 to 86 years. The flap size ranged from 12 × 20 cm to 15 × 28 cm. To augment the viability of the ALT flap, we performed an additional microvascular augmentation of the distal or descending branch of the lateral circumflex artery (LCFA) with the sizable AMT perforator. The extended ALT turbocharged flaps survived completely without peripheral necrosis. The average flap width to circumference ratio of the deep tissues including muscles of thigh was 0.379, and the patients' average harvested flaps width and thigh circumference were 14.3 cm and 40.2 cm, respectively. The mean follow-up was 9.3 months. No complications were recorded during the follow-up. We believe that augmentation of the ALT and AMT perforator flaps by turbocharging can repair wide soft tissue defects. This method may be another promising option when reconstructing wide defects in the supine position.