Video‐Assisted ALT Harvesting, Technique Validation, and Results

Abstract

Objective: We have previously described a novel video-assisted technique (VAT) for the identification of cutaneous perforators of the anterolateral thigh (ALT) free flap. We sought to validate the technique by comparing its findings with standard open thigh exploration in a series of consecutive patients. Method: Retrospective review of a prospectively collected database; 23 consecutive cases operated at a tertiary academic institution between September 2010 and October 2011. In all these cases a standard open exploration of the thigh—considered the gold standard—was performed immediately after the endoscopic exploration. Data retrieved included surgical findings, demographics, and outcomes. Results: There were 16 males and 7 females with a mean age of 55 (23-83). The most common defect location was cutaneous n = 7 (30.4%) and oral cavity in n = 6 (26.1%). Average operative time for VAT was 25.4 minutes (9-47). On standard exploration there were 53 total perforators identified; 49 of these were successfully identified endoscopically. Findings were discordant in 4 cases (17.4%), with the endoscopic technique missing 1 perforator in all of 4 of them. The sensitivity of VAT was 92.4% (CI, 80.9-97.5) with a correlation coefficient of 0.91 with open exploration. All flaps survived, and there were no complications associated with the technique. Conclusion: Video-assisted exploration has a high sensitivity for identification of cutaneous perforators of the thigh. There is a high correlation between findings with this technique and a standard open approach. This minimally invasive technique could help minimize donor site morbidity in patients undergoing reconstruction with an ALT free flap.