A Reliable Soft Tissue Reconstruction Method Using Pedicled Anterolateral Thigh Flaps: From the Lower Abdomen to the Distal Lower Leg

Background: Soft tissue reconstruction of the lower abdomen, inguinal and perineum region, and the lower limbs is challenging(1,2). The anterolateral thigh (ALT) flap is widely used for soft tissue defect reconstruction due to its reliable anatomy and large soft tissue availability(3-6). The pedicled ALT flap can be applied for adjacent soft tissue defect coverage without vessel anastomosis.

Patients and Methods: Twelve patients who had undergone pedicled ALT flap for soft tissue reconstruction in our hospital from March 2010 to November 2017 were included. Surgical fields ranged from the lower abdomen to the distal lower third of the leg. There were 6 distally based pedicled ALT flaps with the reverse flow for lower limb reconstruction. Four cases occurred in the inguinal area and one occurred in the scrotum due to Fournier’s gangrene. One patient underwent reconstruction for an abdominal fascia defect.

Results: No surgery-related mortality occurred, and all the flaps survived. The donor sites were primarily closed without post-operative complication. All the patients achieved satisfactory results.

Conclusion: The pedicled anterolateral thigh flap has several advantages as a locoregional flap with minimal complication. It has wide applications for the treatment of soft tissue defects occurring in the lower abdomen to lower the third portion of the leg.

Ref:

1. Daigeler A, Simidjiiska-Belyaeva M, Drucke D, et al. The versatility of the pedicled vertical rectus abdominis myocutaneous flap in oncologic patients. Langenbecks Arch Surg 2011;396:1271-1279

2. McCraw JB, Fishman JH, Sharzar LA. The versatile gastrocnemius myocutaneous flap. Plast Reconstr Surg 1978;62:15Y23

3. Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002;109: 2219-2226.

4. Lee YC, Chiu HY, Shieh SJ. The clinical application of anterolateral thigh flap. Plast Surg Int 2011; 2011:127353.

5. Wong CH, Lin CH, Fu B, et al. Reconstruction of complex abdominal wall defects with free flaps: indications and clinical outcome. Plast Reconstr Surg 2009;124:500Y509

6. Kimata Y, Uchiyama K, Ebihara S, et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 2000;106:584