Rotation arc of pedicled anterolateral thigh flap for abdominal wall reconstruction: How far can it reach?

Abstract

The aim of this study was to elucidate the extent to which pedicled anterolateral thigh (ALT) flaps can reach in reconstruction of abdominal wall defects. A total of 60 pedicled ALT flaps were raised from cadavers and were experimentally transferred to the abdominal region. The distance between the umbilicus and the most cranial point of the flap after transfer was defined as cranially reachable distance (CRD). Three issues were evaluated: (1) the difference in the CRD when the flap pedicle was positioned superficial or deep into the rectus femoris (RF) and sartorius (SA) muscles; (2) the difference in the CRD in those cases where the main artery of RF arises from the descending branch of the lateral femoral circumflex artery, and is preserved or severed; and (3) maximum values of CRD. (1) CRD was significantly greater when the pedicle was passed deep into the muscles (-2.5±3.8 SD cm) compared with superficial (-5.8±3.3 SD cm), indicating placement of pedicles beneath the two muscles enables additional extension. (2) CRD was significantly greater for the severed condition (-0.3±4.0 SD cm) than for the preserved condition (-3.3±4.1 SD cm), indicating severing the main artery of RF allows additional extension. (3) Out of the 60 specimens, the CRD was cranial to the umbilicus in 17 flaps, indicating pedicled ALT flaps can reach the umbilicus in less than one-third (17/60) of cases. Pedicled ALT flaps can reliably reach regions inferior to the umbilicus. However, for defects superior to the umbilicus, other reconstructive options should be considered.