Lower Extremity Reconstruction with the Microsurgical Neurosensitive Anterolateral Thigh Flap. Its Impact on Ambulation

Purpose: The versatility and location of the anterolateral thigh flap (ALT) make it well suited for lower extremity reconstruction. The purpose of this study was to evaluate surgical and functional outcomes by specific anatomic regions in the foot to better define the role of the neurosensitive anterolateral thigh flap in lower extremity reconstruction.

 Objective: To determine that the neurosensitive microvascular anterolateral thigh flap provides adequate vascularized skin cover and protective sensitivity for foot reconstruction, allowing the patient to recover weight bearing and ambulation.

  Method: A prospective, longitudinal and observational study was performed, using 20 patients undergoing lower extremity reconstruction with a neurosensitive ALT flap between October 2015 and October 2016 was performed. Sensitive monofilament test and two-point discrimination test were performed before surgery and 6, 12 and 18 months after the procedure.

 Results: All cases had a microvascular free flap. Defects were located in the forefoot (40%), midfoot (30%) and hindfoot (20%) and ankle (10%)The mean postoperative follow-up was 12 months. There wasn’t any total flap loss. There were 3 cases (15%) of partial dehiscence and one case of donor site infection.  There were 2 recipient site complications (10%) of infection, solved by antibiotic therapy. Average of hospitalization stay was 14 days. Partial weight bearing began at an average of 4 weeks, and bipedal gait began at 7 weeks. During the follow-up, all 20 cases achieved full weight bearing, acceptable contour and quality of gait. All cases achieved protective sensitivity and 60% achieved discrimination sensitivity. Overall, 18 patients (90%) returned to their preoperative functional status.

 Conclusion: The variety of ways in which ALT flap reconstructions can be performed suits the diverse tissue requirements of the entire lower extremity especially in the foot where the sensitivity plays a fundamental role in ambulation. In selected patients, neurosensitive microvascular ALT flaps can provide good surgical and functional results and  is an effective method of lower extremity reconstruction.