Versatility of the Pedicled ALT Flap in Defect Reconstruction: Experience of a Unit in Rural Sub-Saharan African

Peter Nthumba

doi:10.4314/aas.v15i1.8

Abstract

Background : The free anterolateral thigh flap with its large caliber vessels, a reliable skin territory and minimal donor site morbidity is the reconstructive surgeons’ workhorse. The pedicled flap though not as popular, has been used extensively for the reconstruction of defects from the mid-leg to the epigastrium. The favorable profile of the anterolateral thigh flap, with minimal variability of its vascular anatomy and donor site complications is well described in most races; literature of its use in sub-Saharan Africa is scanty. Methods : The author describes the use of the anterolateral thigh flap in a series of 17 patients in a rural African hospital, illustrating its versatility as well as the complications associated with its use in this patient population. Results : Seventeen patients withtwenty antero-lateral thigh flaps were followed for an average of 24 months. Conclusions : The pedicled antero-lateral thigh flap is an excellent reconstructive tool with very good results in the black African population. This versatile flap has low donor site morbidity. The risk of developing hypertrophic scars and keloids remains a real concern in Black patients and longer term follow-up and a larger number of patients are needed to establish this potential complication. Key words : Anterolateral thigh flap, Africa

Highlights

The free anterolateral thigh (ALT) flap with its large caliber vessels, reliable skin territory and minimal donor site morbidity is the reconstructive surgeons’ workhorse
Flap components can be customized depending on the needs of the defect to include any or all of the following: skin paddle(s), fascia, and vastus lateralis muscle
In black Africans on the other hand, the ALT flap vascular anatomy is largely presumed to be similar to that described in other races as reported anatomical and clinical studies are scanty [7]

Summary

Introduction

The free anterolateral thigh (ALT) flap with its large caliber vessels, reliable skin territory and minimal donor site morbidity is the reconstructive surgeons’ workhorse. The pedicled ALT flap though not as popular, has been used for the reconstruction of defects from mid-leg to the epigastrium [1,2,3,4,5]. In black Africans on the other hand, the ALT flap vascular anatomy is largely presumed to be similar to that described in other races as reported anatomical and clinical studies are scanty [7]. While skin flap perforators classically originate from the descending branch of the lateral circumflex femoral artery, a wide variability including complete absence has been described [8]. The ANNALS of AFRICAN SURGERYI www.annalsofafricansurgery.com Nthumba et al Versatility of the Pedicled ALT Flap in Defect Reconstruction

17 M 40 Fournier’s

Methods

Findings

Discussion

Conclusion