PURPOSE: Identification of a single donor site capable of providing all the components of the soft tissue envelope and the ability to selectively harvest a subset of these components is a central requirement for the microvascular reconstruction of the trauma patient. The anterolateral thigh topography based on the lateral circumflex arterial system possesses the capacity to fulfill this role. We investigated the utility of the anterolateral thigh as a donor for microvascular tissue reconstruction to determine its superiority over other donor sites for reconstruction of traumatic defects of the head and neck, upper extremity, torso, and lower extremity in a U. S. Level I trauma center.
METHODS: In order to investigate potential versatility of the anterolateral thigh region donor site a retrospective chart review was conducted of all trauma patients treated by the plastic surgery service at the R Adams Cowley Shock Trauma Center who required microsurgical free flap coverage from July 2002 to October 2004. Forty-eight patients underwent reconstruction of traumatic deformities with tissues from the anterolateral thigh region based on the lateral circumflex femoral artery system during this study period.
RESULTS: Of the 48 patients, 35 were male and 13 patients were female with an average age of 39 years (range 13 to 74 years). Recipient site locations were lower extremity (38 flaps), upper extremity (4 flaps), trunk (one flap), and head and neck (5 flaps). Analysis of flap anatomy revealed 30 fasciocutaneous, 11 myocutaneous, 2 adipofascial, 3 muscle, and 2 adipocutaneous. Seven flaps were based on septocutaneous perforators (15%), while the remainder contained myocutaneous perforators. The donor site closure was also evaluated and 9 thigh donor sites required a split thickness skin graft (19%), while 39 could be closed primarily (81%). The size of the flaps ranged from 36 cm2 (6 cm by 6 cm) to 600 cm2 (20 cm by 30 cm), with an average of 185 cm2 (standard deviation 118 cm2). Three flaps failed as a result of either venous congestion or infection, resulting in a 94% success rate.
CONCLUSION: The anterolateral thigh region provides all required components of the soft tissue envelope for reconstructing patients in a Level I trauma center with a multiplicity of complex deformities. In the large majority of cases the donor site could be primarily closed, and the anterolateral thigh flap also often allowed primary skin closure of the reconstructed wound, which was especially valuable in the distal lower extremity and ankle. Analysis of our institutional experience demonstrates that the majority of cases were fasciocutaneous, however we were able to adapt and tailor the flaps to the defect as evidenced by the range of defects reconstructed. Further, the anterolateral thigh is a predictable donor site which facilitates a two-team approach. Our results suggest the anterolateral thigh region is a warehouse of reliable tissues and can become the ideal donor site for management of complex traumatic wounds of the head and neck, torso and extremities in the United States.