Anteromedial Thigh Flap Research Articles

TFL Perforator Flap Complementing and Completing the ALT-AMT Flap Axis.

Background Anterolateral thigh (ALT) flap is the most common soft tissue flap used for microvascular reconstruction of head and neck. Its harvest is associated with some unpredictability due to variability in perforator characteristics, injury or unfavorable configuration for complex defects. Anteromedial thigh (AMT) flap is an option, but the low incidence and thickness restrict its utility. Tensor fascia lata (TFL) perforator (TFLP) flap is an excellent option to complement ALT. Its perforator is consistent, robust, in vicinity, and lends itself with the ALT perforator. Methods This study was an analysis of 29 cases with a free flap for head neck reconstruction with an element of TFLP flap from July 2017 to May 2021. Results All cases were primarily planned for an ALT reconstruction. There was absence of the ALT perforator in 16 cases but a sizable TFL perforator was available. In 13 cases, the complex defect warranted use of both ALT plus TFL in a conjoint (5), chimeric (5), and multiple (3) free flaps manner. Most common perforator location was septocutaneous between the TFL and gluteus medius. There was complete flap loss in two cases and partial necrosis in two. No adjuvant therapy was delayed. Conclusion TFLP can reliably complement the ALT/AMT axis. Chimeric ALT-TFL can be harvested for large, complex, multicomponent, and multidimensional defects.

Distally Based Anterolateral Thigh Flap Algorithm for Unexpected Situations during Soft-Tissue Defect Reconstruction around the Knee.

The distally based (d) anterolateral thigh (ALT) flap is an effective option for soft-tissue reconstruction around the knee; however, unexpected situations may occur intraoperatively, impeding flap harvest. The authors proposed an algorithm for surgical conversion for unexpected situations encountered intraoperatively. Between 2010 and 2021, 61 dALT flap harvests were attempted for soft-tissue defect reconstruction around the knee; 25 patients underwent surgical conversion for anomalies, including lack of a suitable perforator, hypoplasia of the descending branch, and compromised reverse flow from the descending branch. After excluding improper cases, 35 flaps were harvested as planned (group A) and 21 surgical conversion cases (group B) were finally enrolled for analysis. An algorithm was developed based on the cases in group B. Outcomes, including complication and flap loss rates, were compared between groups to verify the algorithm's rationality. In group B, the dALT flap was converted to a distally based anteromedial thigh flap ( n = 8), bipedicled dALT flap ( n = 4), distally based rectus femoris muscle flap ( n = 3), free ALT flap ( n = 2), or other locoregional flap that required additional incision ( n = 4). No differences in outcomes were observed between the two groups. The proposed contingency planning algorithm for dALT flap surgery proved rational, as surgical conversion could be made by means of the same incision in most cases, and outcomes generated by the algorithm were acceptable. Therapeutic, IV.

Technique and clinical application of free lobed anteromedial thigh perforator flap

To introduce the technique and clinical application of free lobed anteromedial thigh perforator flap. Between October 2017 and December 2021, 65 patients with buccal and oral cancer penetrating defects were planned to treat with free lobed anterolateral thigh flap transplantation, of which 15 cases were found that the sole anterolateral thigh perforator was actually a branch of the anteromedial thigh perforator, and then the free lobed anteromedial thigh perforator flap was harvested for repair. There were 12 males and 3 females with an average age of 34.6 years (range, 29-55 years). According to Union for International Cancer Control (UICC) TNM staging, there were 7 cases of T 4N 0M 0, 4 cases of T 4N 1M 0, 2 cases of T 3N 1M 0, and 2 cases of T 3N 2M 0. The disease duration was 1-10 months (mean, 6.3 months), and the area of secondary soft tissue defect left after radical resection of buccal and oral cancer was from 5 cm×4 cm to 10 cm×6 cm. The anterolateral thigh skin flap ranged from 5 cm×4 cm to 13 cm×6 cm, and the anteromedial thigh skin flap ranged from 5 cm×3 cm to 10 cm×6 cm. The free trilobed anteromedial thigh flap was prepared according to the actual branches of the main trunk of the anteromedial thigh perforator in 4 cases, and the vastus medialis muscle flap was used to fill the cavity defect of the floor of mouth in 7 cases. Among the 15 patients, the vessel pedicles of the anteromedial thigh perforators were derived from the main femoral artery and vein in 8 cases, from the main descending branch of the lateral femoral circumflex artery in 4 cases, and from the main lateral femoral circumflex artery in 3 cases. Hematoma occurred in 2 cases after operation, which was successfully saved after emergency exploration. No vascular crisis occurred, and partial necrosis of anterolateral femoral skin island occurred in 1 case, which was healed with debridement. The remaining flaps survived successfully, and the wounds and donor site incisions healed by first intention. All the patients were followed up 12-36 months (mean, 14.6 months). The appearance of the flap was satisfactory, and no obvious swelling was found; the mouth opening and language function were satisfactory; only linear scar was left in the donor area, and the thigh function was not significantly affected. Local recurrence occurred in 3 cases, and the defect after tumor resection was repaired with pedicled pectoralis major myocutaneous flap. Four patients with neck lymph node metastasis, including ipsilateral side in 3 patients and contralateral side in the other 1 patient, all underwent neck lymph node dissection again. The 3-year survival rate was 86.7% (13/15). The anteromedial thigh perforator vessels distributed in the anterolateral region of the thigh can be used to prepare the anterolateral thigh split lobed flap to repair the buccal and oral cancer penetrating defects.

Vascular Anatomy of the Anteromedial Thigh Flap: A Systematic Review.

Background:While the anterolateral thigh (ALT) flap is the most commonly employed thigh-based flap for microvascular reconstruction, its counterpart, the anteromedial thigh (AMT) flap, is a useful but underdescribed alternative when ALT perforators are absent or lacking. This review aims to assess the existing literature describing the anatomy and vascular territories supplying the AMT flap.Methods:A systematic review was performed in accordance with PRISMA guidelines. Ovid MEDLINE, Embase, and Web of Science were queried for records pertaining to the study question using Medical Subject Heading terms such as “anteromedial thigh flap” and “free tissue transfer.” Study characteristics and anatomic descriptors (including number and type of perforators, origin, and pedicle course supplying the AMT flap) were collected.Results:A total of 21 studies representing 723 AMT flaps were identified and included for analysis. Dominant perforators supplying the AMT flap most commonly included the descending lateral circumflex femoral artery (dLCFA; 35%) or the medial branch of the dLCFA (mdLCFA; 33.6%). Average pedicle length ranged from 7.5 to 10.6cm. The majority of AMT perforators were septocutaneous (n = 852, 63.8%) compared with musculocutaneous (n = 483, 36.2%). Perforators to the AMT were absent in 7.6 to 9.1% of clinical cases.Conclusions:The variable vascular anatomy of the AMT flap has prevented its widespread adoption in reconstruction. As knowledge regarding pertinent perforator anatomy of the AMT flap increases, so may its utility as an alternative to the ALT flap. This review summarizes the spectrum of anatomy of the AMT vasculature described in the literature to date.

Perforators of the Anteromedial Thigh Skin and Possible Design of the Anteromedial Thigh Flap: A Cadaveric Study.

Specific perforator-based flaps are a new era in plastic reconstruction. They have replaced many of the traditional paradigms in plastic surgery. The anteromedial thigh flap is a versatile flap that can be used as a primary choice for many reconstructive purposes or as a secondary choice for the anterolateral thigh flap. Mapping the vascular territory of anteromedial thigh is essential for the proper design of the flap. The aim of this work was to study the cutaneous perforators of the anteromedial thigh and explain their significance in flap design. The material of this study included 30 fresh cadaveric lower limbs. The external iliac artery was injected with colored latex. Superficial and deep dissections were undertaken under a magnifying lens to locate the perforators and identify their type. The length and diameter of the perforators were measured. Anteromedial thigh skin was divided into 6 squares. Squares 1 and 4 are the upper squares and comprise the skin over the upper medial thigh. It is primarily based on the superficial external pudendal artery, deep external pudendal artery, and superficial circumflex femoral artery. Squares 2 and 5 are the middle squares and were mainly supplied by perforators of the superficial femoral artery. Squares 3 and 6 are the lower squares and were mainly supplied by the saphenous artery and superficial femoral artery. The possible flap designs are then discussed. The anteromedial thigh skin is richly supplied by a mixture of perforators from multiple sources. The segmental nature of the perforators arising from the superficial external pudendal artery, deep external pudendal artery, superficial femoral artery, and saphenous artery together with the long course and large diameter of perforators grant the anteromedial thigh flap its versatility.

A Comparison of Accuracy between Dynamic Infrared Thermography (DIRT) and Handheld Doppler Ultrasonography in Free Flap Reconstruction Perforator Mapping: A Prospective Study

Background: Preoperative perforator mapping is one of fundamental steps for successful surgery in microsurgical perforator free flap. Currently, there is still no gold standard for preoperative perforator mapping. Objective: The present study aims to compare accuracy in perforator mapping between dynamic infrared thermography (DIRT) and handheld doppler which is the main method we used in our hospital. Materials and Methods: Twenty patients scheduled for microsurgical free flap reconstruction between October 2018 to December 2020 was enrolled. Preoperative perforator mapping was performed by both handheld doppler and smartphone dynamic infrared thermography (DIRT). During rewarming period, “Hot spots” were marked. Then flaps were raised intraoperatively, numbers, diameter and location of each perforators were recorded. Location of perforators at its piercing fascia were reflected to skin. Distance from actual perforators to the nearest preoperative perforator marking point by each method were measured. Results: There were 9 male and 11 female patients enrolled in the present study with mean age of 54.30 years. The average body mass index was 23.85 kg/m2. Hand-held doppler and DIRT images were obtained for 20 flaps, including 15 anterolateral thigh flaps (75%), 1 anteromedial thigh flap (5%) and 4 fibular free flaps (20%). The mean caliber of selected perforators was 2.62 mm at point of their emergence through fascia. All the flap survived without postoperative major complication. The mean distance from actual perforator to the nearest perforator from handheld doppler was 11.88+7.51 mm, and to the nearest perforator from thermal images was 12.68+8.96 mm. The mean distance difference of both methods was 0.80 mm. Perforators were usually within a 20 mm radius of preoperative marking both handheld doppler and DIRT. Conclusion: Dynamic infrared thermography is low cost, non-invasive and reliable methods for preoperative perforator mapping. Keywords: Dynamic infrared thermography; Handheld doppler ultrasonography; Perforator mapping; DIRT; Perforator free flap

Freestyle chimeric anterolateral and anteromedial thigh flaps based on the perforators directly arising from superficial femoral artery: an unusual finding

Freestyle chimeric anterolateral and anteromedial thigh flaps based on the perforators directly arising from superficial femoral artery: an unusual finding

Femoral artery-nourished anteromedial thigh flap: A new perspective in oral and maxillofacial defect reconstruction

ObjectivesThe aim of this study was to evaluate the feasibility and efficacy of the femoral artery (FA)-nourished anteromedial thigh (AMT) flap for reconstructing oral and maxillofacial defects. Patients and methodsThe authors analyzed a retrospective case series of 13 patients who underwent the reconstruction of oral and maxillofacial defects with the FA-nourished AMT flap. The flap design and the methods for defect reconstruction are described, and the reconstructive efficacy is reported. ResultsOf the 13 patients, 12 were men, and 1 was woman, with an average age of 52.2 years. Of these FA-supplied AMT flaps, 7 were singly used, 5 were combined with the anterolateral thigh (ALT) flap or its chimeric flaps, and 1 was separately used with the ALT flap. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. ConclusionsThe FA-nourished AMT flap can also be used to reconstruct some common oral and maxillofacial defects, especially as a new alternative to the ALT flap. In addition, this flap can be combined with the ALT flap or its chimeric flaps or separately used with the ALT flap for the reconstruction of complex defects.

Анатомия сосудистой системы переднелатерального бедренного лоскута

Aim: to analyze the anterolateral thigh flap use to eliminate oncological defects in the head and neck area with an emphasis on the flap raising characteristics. Patients and Methods: 146 patients aged 33 to 80 y.o. underwent the surgery in the period from 2011 to 2020. Single-stage reconstruction (143 surgeries) of the various parts of the upper aerodigestive tract (142 surgeries) was mainly performed. Most of the patients (130 cases) underwent the surgery at the first stage of antitumor treatment. In 13 cases, surgical treatment was performed concerning tumor recurrences; in 3 — delayed secondary reconstruction was performed. Flap raising was conducted according to the generally accepted method without the use of preoperative mapping of perforators. The surgery protocols and medical histories were analyzed for the patterns of vascular anatomy and the number and nature of flap-related complications. Results: typical vascular anatomy was noted in 115 cases (78.8%). When raising 31 flaps, anatomical deviations of the course and origin of cutaneous perforators were noted, which can be divided into 4 types: oblique branch anomaly (11 cases), upper type of anterolateral thigh flap (11), anteromedial thigh flap (6) and the rectus femoris muscle (3), while the latter type is rarely mentioned in the literature. The descending branch was the source of cutaneous perforator in 133 cases (91.1%). In 6 cases (3.9%), unfavourable vascular anatomy forced the use of a contralateral hip as a donor area. The reason for the failure in one of these cases was hypoplasia of the descending branch. The primary wound closure of the hip was performed in 143 patients (97.9%), even though the flap width exceeded 8 cm in 7 cases. Postoperative mortality was 1.4%. The main complications associated with the flap included: total flap loss (9 cases; 6.2%), partial necrosis (6; 4.1%) and donor wound complications (8; 5.5%). Conclusion: the anterolateral thigh flap is an excellent plastic material, however, it requires knowledge of the vascular anatomy characteristics of adjacent hip zones. KEYWORDS: head and neck surgery, reconstructive surgery, reconstructive microsurgery, free revascularized flaps, anterolateral thigh flap. FOR CITATION: Karpenko A.V., Sibgatullin R.R., Boyko A.A. et al. Vascular system anatomy of the anterolateral thigh flap. Russian Medical Inquiry. 2021;5(8):517–524 (in Russ.). DOI: 10.32364/2587-6821-2021-5-8-517-524.

Phalloplasty Due to Complete Peno-Scrotal Amputation: A Report of Surgical Technique

Total penile reconstruction is a challenging procedure considering the anatomy and physiology of the organ. A lot of penile reconstructions have been done in the past and many options have been considered, yet there are still problems associated with either function or aesthesis. Many options that were used are still leaving some dissatisfactory. The authors decided to use the anteromedial thigh flap for penile reconstruction which is not a common choice for total phalloplasty. The anteromedial thigh flap is a veritable tool in scrotoplasty. Thus, we present the use of double anteromedial thigh flaps for the reconstruction of the penis.

Comparison of the outcomes between free anteromedial thigh flap and anterolateral thigh flap in head and neck cancer reconstruction: Analysis of propensity-score-matched patient cohorts.

The anterolateral thigh (ALT) flap is a workhorse flap in head and neck cancer reconstruction. The anteromedial thigh (AMT) flap was developed as a rescue or alternative flap whenever the ALT flap is not available; however, the harvest of AMT flap seems to be more challenging in the sense that perforators have multiple variations. This study was designed to compare the outcome of the AMT and ALT flaps in head and neck cancer reconstruction. A total of 1,547 ALT and 57 AMT flaps were used for head and neck cancer reconstruction between March 1, 2008 and February 28, 2017. Differences in patient and operative characteristics were compared between the patients undergoing AMT and ALT flap reconstruction. The primary outcome of the free flap was its survival or failure, while the second outcome was the associated complications. Compared to those who had ALT flap reconstruction, the patients who underwent AMT flap reconstruction had a higher rate of conditions that required reconstruction after previous cancer ablation and recurrence but a lower rate of primary cancer and deeply located cancer. Analysis of the 40 well-balanced pairs of propensity-score-matched patient cohorts revealed that the AMT flaps were associated with a significantly higher failure rate than the ALT flaps (15.0 vs. 0.0%, respectively; p = .026). This study revealed that AMT flaps were associated with a significantly higher failure rate than ALT flaps in head and neck cancer reconstruction in the cohort of total patients and the propensity-score-matched cohorts.

Retropharyngeal Internal Carotid Artery Management in TORS Using Microvascular Reconstruction.

Guidelines for transoral robotic surgery (TORS) have generally regarded patients with retropharyngeal carotid arteries as contraindicated for surgery due to a theoretical risk of intraoperative vascular injury and/or perioperative cerebrovascular accident. We aimed to demonstrate that careful TORS-assisted resection and free flap coverage could not only avoid intraoperative injury and provide a physical barrier for vessel coverage but also achieve adequate margin control. Retrospective cohort analysis. Retrospective review of patients with oropharyngeal malignancies and radiologically confirmed retropharyngeal carotid arteries who underwent TORS, concurrent neck dissection, and free flap reconstruction between 2015 and 2019. Twenty patients were included, 19 (95.0%) with tonsillar tumors and one (5.0%) with a tongue base tumor with significant tonsillar extension. Eighteen patients (90.0%) received a radial artery forearm flap, one (5.0%) an ulnar artery forearm flap, and one (5.0%) an anteromedial thigh flap. All 20 (100%) flaps were inset through combined transcervical and transoral approaches without mandibulotomy. There were no perioperative mortalities, carotid injuries, oropharyngeal bleeds, cervical hematomas, or cerebrovascular accidents. One patient (5.0%) had a free flap failure requiring explant. All patients underwent decannulation and resumed a full oral diet. The mean length of hospitalization was 6.8 (standard deviation 1.2) days. One (5.0%) patient had a positive margin. In this analysis, 20 patients with oropharyngeal malignancy and retropharyngeal carotid arteries underwent TORS, neck dissection, and microvascular reconstruction without serious complication (perioperative mortality, vascular injury, or neurologic sequalae) with an acceptable negative margin rate. These results may lead to a reconsideration of a commonly held contraindication to TORS. 3 Laryngoscope, 131:E821-E827, 2021.

Application of anteromedial thigh flap as a alternative flap in maxillofacial soft tissue defects

Objective:To explore the application value of anteromedial thigh flap（AMT） as alternative flap in repairing maxillofacial soft tissue defects. Method:Sixty patients were scheduled to underwent anterolateral thigh flap（ALT） reconstruction. Preoperative CT angiography were conducted. Imaging workstations were used to locate perforator vessels in the anterolateral and anteromedial areas respectively. Four patients had no suitable perforator during the preparation of AMT flaps. In the same operation area, ALT flaps were prepared to reconstruct the defect according to the location of the perforator vessels in the anteromedial areas. Result:All four AMT flaps survived uneventfully. Flap sizes ranged from 9 cm×6 cm to 7 cm×4 cm. The follow-up period ranged from 6 to 12 months, the functions of recipient and donor sites recovered well. Conclusion:Preoperative CT angiography can improve the accuracy of the preparation of skin flap effectively. When no sizable perforator is available during harvest of the ALT flap, successful reconstruction can be achieved using the ipsilateral AMT flap.

Management of Intraoperative Failure of Anterolateral Thigh Flap Transplantation in Head and Neck Reconstruction

The aim of the present study was to explore the remedial methods for the failure of anterolateral thigh (ALT) flap transplantation and to evaluate the efficacy of these methods in head and neck reconstruction. We performed a retrospective study of 11 patients who experienced intraoperative failure of ALT flap transplantation in head and neck reconstruction that was successfully salvaged with the same donor site. The cause of flap failure, corresponding management, and complications at the donor and recipient sites were recorded. All 11 patients were men with an average age of 56.5years. Of the 11 cases of flap preparation or transplantation failure, 1 was caused by arterial thromboembolism (after vascular anastomosis), 4 by perforator injury, 4 by mistaken perforator ligation, 1 by perforator thromboembolism, and 1 by the perforator deep penetration in muscle. All were successfully rescued with the same donor site, including harvest of another ALT flap with the other perforator in 5 patients, elevation of an anteromedial thigh flap in 4, and perforator anastomosis in 2 patients. With effective remedial methods for the failure of flap transplantation and their great versatility, the use of ALT flaps is a good choice for reconstruction of head and neck defects.

Incidence of inadequate perforators and salvage options for the anterior lateral thigh free flap.

The anterolateral thigh (ALT) free flap is a soft tissue flap used in head and neck reconstruction. Occasionally, its perforators to the skin paddle are absent or too small to support the flap. Salvage options in this scenario have not been well described for head and neck reconstruction. Multicenter review of 1,079 cases of planned ALT flaps where 28 initial flaps (2.6%) were discarded for nonviable skin paddle or lack of cutaneous perforators. Iatrogenic perforator injury was calculated separately. The total flap loss rate was 3.2%. In 12 cases, no perforators were noted after performing the anterior incision (early). Sixteen ALT flaps were discarded immediately before pedicle ligation (late). Reconstruction was salvaged by seven anteromedial thigh (AMT), six radial forearm, five contralateral ALT, four rectus abdominus myocutaneous, three vastus lateralis, three profunda artery perforator, two tensor fascia lata, one rectus femoris, two pectoralis major, one cervicofacial rotational, and one fibula flap. Of the 28 cases, 12 salvage cases did not involve an additional wound for the patient. Five of the seven AMT flaps were harvested after the ALT was identified as nonviable in the early time point. Two patients had no viable ALT flaps on bilateral lower extremities. The ALT flap is a reliable soft tissue flap, and rarely cutaneous perforators are not adequate to support the skin paddle. Multiple options exist to salvage the reconstruction without significant additional morbidity to the patient if said inadequacy is identified early. 4 Laryngoscope, 130:343-346, 2020.

Early Detection of Vascular Obstruction in Microvascular Flaps Using a Thermographic Camera.

In microsurgical reconstruction, vascular obstruction occurs in approximately 20% of patients. Close monitoring is central to their care. Clinical/Doppler detection of vascular obstruction could be enhanced by thermography. A diagnostic test design included consecutive cases of hospitalized patients, ≥18 years old, who underwent surgery with free flaps. Two researchers separately evaluated patients with clinical/Doppler methods and thermographic camera hourly for 24 hours, every 2 hours for the next 24 hours, and then every 3 hours until discharge. The gold standard was visualization of thrombus or vascular obstruction during surgical reintervention. Sensitivity, specificity, positive/negative predictive value (PPV/NPV), and a delta temperature receiver operating characteristic (ROC) curve were calculated. A total of 2,364 tests were performed with a thermographic camera in 40 patients (31 females, 9 males) aged 50.12 ± 9.7 years. There were 28 deep inferior epigastric perforator, 5 anterolateral thigh, 3 radial, 2 scapular, 1 fibular, and 1 anteromedial thigh flaps included. Six (15%) had postoperative vascular obstruction (5 venous and 1 arterial). One flap developed partial necrosis and one total necrosis (overall survival 97.5%). ROC curve (area 0.97) showed the best results at ≥ 1.8°C of difference to the surrounding skin. Considering two consecutive positive evaluations, the sensitivity was 93%, specificity 96%, PPV 57%, and NPV 99%. The thermal imaging camera allows to identify the obstruction between 2 and 12 hours before the clinical method. Utilizing a thermographic camera can reduce detection time of vascular obstruction by several hours in microvascular free flaps that include the cutaneous island. This method proves useful for early diagnosis of postoperative vascular obstruction.

Reconstruction of scrotum with anteromedial thigh flap

Background: Reconstruction of extensive defects of the perineum and scrotal region, with exposure of the testes, following avulsion injury or severe infections represents a significant challenge. Replacement with sensate, durable cover is mandatory for functional, cosmetic, and psychological reasons. A wide range of flap techniques has been reported for this purpose with their advantages and disadvantages. We describe the use of the anteromedial thigh flap in our case series with the advantages and disadvantages. Materials and Methods: We had seven patients in our series, of which two patients were posttraumatic defects and other five were post-Fournier’s gangrene unilateral scrotal defects. We describe few case examples in the series in detail, of which the first patient was 21-year-old labor who presented with avulsion injury to penis and scrotum. He had a loss of scrotal skin near totally, except for 2cm × 2cm areas posteroinferiorly. In addition, he also had a loss of penile skin from the glans to the base of the penis. We used bilateral anteromedial thigh fasciocutaneous flap based on the longitudinal axiality of the anteromedial thigh suprafascial plexus for reconstruction. The patient had an excellent recovery, a good aesthetic result at the end of 1 year. Another posttraumatic defect was unilateral and the patient also had a good recovery.The other five patients in series were of Fournier’s gangrene. All patients underwent initially debridement and then flap cover on day 7. All of them needed unilateral scrotal reconstruction. The unilateral anteromedial flap was carried out with good recovery at the end of the 6 weeks. Results: This flap has provided nice durable cover for the testes with an acceptable aesthetic appearance, although the color match was not good in case 3 of the series. Conclusion: In conclusion, anteromedial fasciocutaneous thigh flap is a good choice for scrotal reconstruction that could provide a sensate, durable cover that fulfills patient satisfaction. It is technically easy and has favorable functional and aesthetic results.

Relaying anterolateral thigh (ALT) perforator flap in resurfacing of the donor defect after anteromedial thigh (AMT) perforator flap transfer

Objective To introduce the clinical experience of relaying anterolateral thigh (ALT) flap in the resurfacing of the donor defect after anteromedial thigh (AMT) flap transfer. Methods From February 2014 to December 2015, 16 cases with oral carcinoma underwent radical resection, leaving tongue or mouth floor defects which were reconstructed by AMT perforator flaps. The flap size ranged from 7.5 cm×4.5 cm to 13.0 cm×7.5 cm [the patients was 45.6 years (range 31-72 years), body mass index (BMI) range 17.5-24.3 kg/m2]. Flaps' width was on average 6.6 cm (ranging from 5 to 9 cm) with flap width-to-thigh circumference ratio being 12.5% on average (ranging from 9.8% to 15.7%). The flap donor sites were reconstructed with relaying ALT flap at the same stage, the flap size ranged from 7.5 cm×4.0 cm to 12.0 cm×7.0 cm. Results The AMT and ALT perforators existed consistently in all cases of this serie. All free AMT flaps and relaying ALT flaps survived uneventfully. All patients were followed up for 8-24 months with satisfied esthetic and functional results in recipient and donor sites. 2-point discrimination distance of AMT flaps ranged from 7 to 14 mm, 2-point discrimination distance of relaying ALT flaps ranged from 8 to 15 mm, the function of thighs were not affected. Conclusions The relaying ALT flap is an ideal choice to reconstruct the donor site of free AMT flap. Key words: Surgical flaps; Thigh/SU; Cheek/SU; Skin transplantation

The anteromedial thigh free flap: a primary reconstructive option or second best?

This article reviews the recent literature on the anteromedial thigh free flap. The anteromedial thigh (AMT) free flap is an excellent reconstructive option for head and neck defects. It is often overshadowed by the anterolateral thigh (ALT) free flap. Lack of familiarity with the anatomy of the AMT likely deters many surgeons from considering it as a reliable option. However, as many as one in 20 patients may not have anatomy suitable for ALT free-flap harvest, and in these cases the AMT provides an ideal alternative as it can be harvested through the same incision without added morbidity. Current areas of research include clinical, anatomic, cadaveric, and radiographic studies evaluating the AMT flap anatomy and utility. The AMT flap has been successfully used to reconstruct the same types of soft tissue head and neck defects as the ALT. However, given that approximately 95% of patients appear to have anatomy favorable to harvest an ALT, the utility of the AMT should be reserved for patients with unfavorable lateral thigh anatomy or when when a chimeric flap is indicated and anatomy permits.

Alternative Choices for Anterolateral Thigh Flaps Lacking Suitable Perforators: A Systematic Review.

The anterolateral thigh (ALT) flap has become a predominant option in the field of reconstruction. However, some difficulties in harvesting flap exist due to the anatomical variability of the perforators. Reports have provided solutions for unreliable perforators. Although numerous cases that showed successful conversion to tensor fasciae latae (TFL) flap or anteromedial thigh (AMT) flap have been reported in the literature, none fully addresses the reliability of the perforators that have been described to date. Therefore, we conducted a systematic literature review to compare the reliability of the TFL flap with that of the AMT flap when an ALT flap perforator is not suitable. A systematic review of the MEDLINE, PubMed, and Cochrane Library electronic databases was performed to compare the characteristics of TFL and AMT flap perforators. A total of 13 articles were included for review. The mean number of TFL perforators varied from 1.41 to 3.17 per thigh. The mean number of AMT perforators was between 0.59 and 1.3 per thigh. The cumulative assessment of the clinical and anatomical studies showed 456 perforators in 180 TFL flaps (mean, 2.53) and 145 perforators in 162 AMT flaps (mean, 0.90). The mean pedicle length of the TFL and AMT flaps ranged from 7.0 to 9.59 cm and from 7.4 to 11.0 cm, respectively. The mean perforator diameter was similar in both flaps. Currently available literature suggests that the TFL flap may be a more reliable alternative when adequate perforators are not found for ALT flap harvest.