Abstract
Background The anterolateral thigh (ALT) flap has been amongst the most versatile components of the reconstructive surgeon's armamentarium. The authors utilise these flaps for a variety of reconstructive procedures including lower limb reconstruction; postsarcoma excision; and open fractures. Few studies have discussed the extent of recipient site morbidity and subsequent revisional procedures. We will report our experience of the ALT flap in 92 consecutive reconstructions with focus on recipient site complications and revisional procedures. Methods Retrospective data collection was done from 92 patients who underwent ALT flap reconstruction—for various large soft tissue defects—at our unit at the Royal Free Hospital, London. We evaluated primary recipient site complications and the requirements for secondary operations after flap transfer. Results All flaps survived with the exception of 3 cases (97% survival rate) in which irreversible venous thrombosis was encountered. 16 of 92 patients (17%) required a second recipient site operation for the following: 7 patients experienced major recipient site complications that warranted early return to theatre and 9 patients required a secondary revision thinning procedure(s). 8 of the 16 patients (50%) requiring second operations had construction on their lower leg/ankle/feet (p value = 0.10). Conclusions Our data demonstrated effective use of the ALT flap in the management of soft tissue reconstructive surgery. Partial flap necrosis was the main complication at the recipient site. In future work, secondary thinning procedures, particularly at the ankle/foot, should be separated from flap-specific complications. Furthermore, we demonstrate tailoring ALT thickness can be performed safely without compromising flap viability.
Highlights
Large soft tissue defects remain a reconstructive challenge for plastic surgeons. is is, in part, due to the potential composite loss of tendons, muscles, bones, and overlying soft tissues. e affected area is in need of skin coverage with functional reconstruction and filling of 3-dimensional spaces [1, 2]
Results ere were 3 cases of flap failure in this group (97 percent flap survival rate), all due to irreversible venous thrombosis. 76 of 92 donor sites (83 percent) were closed directly, and 16 (17 percent) were closed using split-thickness skin grafts taken from either the ipsilateral or contralateral thigh. 7 patients (8 percent) experienced a major complication that required return to theatre within one week of the operation. 9 patients (10 percent) required a return to theatre at a later date for a secondary revision procedure(s). ere were no cases of major complications being caused by the donor site
7 patients (8 percent) experienced major recipient site complications necessitating early (
Summary
Large soft tissue defects remain a reconstructive challenge for plastic surgeons. is is, in part, due to the potential composite loss of tendons, muscles, bones, and overlying soft tissues. e affected area is in need of skin coverage with functional reconstruction and filling of 3-dimensional spaces [1, 2]. Large soft tissue defects remain a reconstructive challenge for plastic surgeons. Since its initial description in 1984, the anterolateral thigh (ALT) flap has been amongst the most versatile components of the reconstructive surgeon’s armamentarium [3]. Long pedicle length, and substantial vessel diameter—as well as its variability in terms of design—renders the ALT flap suitable for large, complex, and challenging soft tissue defects. A muscle segment can be included on the same pedicle, increasing the versatility of the flap and providing additional bulk if required. Several case series have described its use in the reconstruction of soft tissue defects within the head, neck, and extremities [6–8]. E former describes those requiring an immediate return to the operating theatre in such cases as microsurgical revision or dehiscence.
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
