Versatility of the lateral circumflex femoral artery sparing perforator-based anterolateral thigh flaps in loco-regional thigh reconstruction after skin cancer, melanoma, and sarcoma resection.

Abstract

The anterolateral thigh (ALT) flap represents a workhorse in reconstructive microsurgery but its use in a free style fashion as perforator-based flap has yet to be popularized. We describe our experience with lateral circumflex femoral artery (LCFA) sparing perforator-based ALT flaps for thigh reconstruction after oncological resection in a case series of 24 consecutive patients. Twenty-four patients underwent thigh reconstruction with 25 perforator-based ALT flaps between 2014 and 2020. Defect etiology was related to skin cancer, melanoma, and sarcoma resection in 3, 7, and 14 cases respectively. Mean defect size was 15 × 8cm. Six months postoperatively, patients were asked to rate on a 5-point Likert scale the aesthetic and functional outcomes of the reconstructive procedure. Eight flaps were advanced in a V-Y fashion (33.3%), whether 16 flaps (66.7%) were rotated in a propeller fashion. The average flap size was 19× 8cm, while mean operative time was 197.2min. Donor sites were always closed by primary intention. Minor complications were registered in 5 cases and managed conservatively. Overall patients' satisfaction was high, with mean aesthetic and functional ratings of 4.46 and 4.21 respectively. LCFA sparing perforator-based ALT flaps proved to be a versatile and reproducible solution to address thigh reconstruction after oncological resection according to the different topographical sub-units involved.