Anterior lateral thigh osteomyocutaneous free flap. The characteristics of the 10 patients who underwent reconstruction of throughandthrough cheek defects with alt flaps, including tumor stage, flap size, type of flap, complications, and so on, are listed in table 1. Free anterolateral thigh flap for reconstruction of upper aerodigestive tract defects. Pdf free anterolateral thigh flaps for upper extremity. According to clinical need, the free alt flap was divided into the musculocutaneous flap and the fasciocutaneous flap. Jun 04, 2016 the anterolateral thigh alt flap is a soft tissue perforator free flap normally pedicled on the descending branch of the lateral circumflex femoral artery lcfa. Free anterolateral thigh flaps for upper extremity soft tissue reconstruction. Anterolateral thigh perforator flap plastic surgery key. This was allowed to pick up a blood supply from this rich vascular bed and mature over a period of 3 weeks before. The alt has a complex local vasculature, which can be of importance for the surgical approach. It can provide abundant soft tissue coverage and minimal donor site morbidity.
This article is from archives of plastic surgery, volume 39. The anterolateral thigh alt flap has widespread use throughout the body because of the many engineering options. It is estimated that about 92,000 new cases of oral cavity and pharyngeal cancer occurred in europe in 2008. Case note analysis was performed to determine demographic and perioperative factors, and complications and outcomes. Jan 18, 2015 chapter 61 anterolateral thigh perforator free flap. A method of reconstructing soft tissue defects to various regions of the body. The purpose of this article is to describe the authors experience using the anterolateral thigh alt flap for the reconstruction of a variety of soft tissue defects. Anterolateral thigh alt free flap pocket dentistry. Use of the anterolateral thigh free flap for upperextremity. Anterolateral thigh perforator free flap request pdf. Versatility of the free anterolateral thigh flap in the reconstruction of. The anterolateral thigh flap is recommended as a free flow. Clinical summary a 69yearold man had a history of excision of a cutaneous. Total posterior leg open wound management with free.
Contralateral pedicled anterolateral thigh flap atl for upper thigh defect in the era of free atl. Risk factors of free anterolateral thigh flap failure for reconstruction. Jan 29, 2011 this versatile free tissue transfer was used to reconstruct a extensive through and through defect of the cheek and neck. Anterolateral thigh alt free flap surgery this leaflet has been written to help your understanding of anterolateral free flap surgery. Flap elevation starts at the medial edge and the skin is incised including the deep fascia of the thigh. By adapting free style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator. A thin layer of fat below scarpas fascia is preserved with the deep fascia to create a thin fat and fascial flap. Pdf free anterolateral thigh flap for reconstruction of. Composite anterolateral thigh flap for achilles tendon. Request pdf anterolateral thigh perforator free flap this chapter deals with a method of reconstructing soft tissue defects to various regions of the body. The characteristics of an ideal softtissue free flap for head and neck. As a free microvascular transfer, it is used to resurface defects throughout the body.
In this report, we present a case in which a free anterolateral thigh alt flap was transferred for head and neck reconstruction after oropharyngeal cancer ablation. The anterolateral thigh alt free flap is one of the most commonly used donor sites in head and neck reconstruction, however, it is not typically considered when an osseous component is needed. Digital content 1, which demonstrates the salt flap technique. Contralateral pedicled anterolateral thigh flap atl for. The anterolateral thigh flap can provide a large skin paddle nourished by a long and largecaliber pedicle and can be harvested by twoteam work. The mission of the ahns is to advance education, research, and quality of care for the head and neck oncology patient. Hurwitz 1 described the first posterior thigh flap in 1980, when he used a musculocutaneous flap based on the inferior gluteal artery.
If the perforators do not arise from the descending branch of the lateral circumflex femoral artery, the flap should be raised as a free flap or a bifurcation of the transverse and. In addition the altf may be combined with the adjacent vastus lateralis muscle. This technique enables both vascular and soft tissue reconstructions simultaneously with minimal donor site problems. Total posterior leg open wound management with free anterolateral thigh flap. This is surgery that removes a piece of skin from your inner forearm and uses it to replace tissue that was removed due to cancer. Images gested reverseflow anterolateral thigh flap and the. Sole reconstruction using anterolateral thigh perforator. Scalp free flap reconstruction using anterolateral thigh. A distally based anterolateral thigh flap, which was first described by zhang in 1990 and optimized by wei in 2015, is associated with consistent anatomy, a wide arc of motion, limited donorsite morbidity, and straightforward dissection. The anterolateral thigh free flap for skull base reconstruction. The role of the anterolateral thigh free flap in reconstructing head and neck defects is ever expanding, with many novel harvesting and reconstructive techniques described in recent years.
Free anterolateral thigh flap in pediatric patients mayo clinic. Contralateral pedicled anterolateral thigh flap world journal of. Additionally, it has a long pedicle with a suitable vessel diameter, which is able to anastomose with the recipient vessels beyond the injured. The anterolateral thigh alt flap represents a workhorse flap in reconstructive surgery. If you have any other questions that the leaflet does not answer or would like a further explanation, please ask your surgeon or cns. With a paucity of recipient vessels in the neck and a previous failed free fibula transfer secondary to osteoradionecrosis, a fibula was implanted into a suprafascial pocket created in the anterolateral thigh. Sandwich fascial anterolateral thigh flap in head and neck. Anterolateral thigh flap reconstruction of full thickness. Free anterolateral thigh flaps for upper extremity soft. It is a vascularised free composite flap containing bone. Abstractwe experienced satisfactory outcomes by synchronously transplanting an artery and vein. The anterolateral thigh flap can be considered to be one of the workhorses of perforator flaps. There are numerous clinical series describing the use of the altf, largely for head and neck reconstructions. Anterolateral thigh perforator free flap elevation youtube.
An algorithm for the use of the anterolateral thigh perforator flap for knee defects. Anatomical variations and preoperative imaging technique. Venous congestion is the complication most frequently associated with a distally based anterolateral thigh. Free anterolateral thigh flap guang yang and kevin c. Narendra hulika, ramana reddy naru, azhagamuthu, basheeruddin inamdar, abha chandra dear editor the radical surgery for fungating inguinal lymph nodes is commonly done in patients with penile and vulvar cancers, creating complex groin defects. Distally based anterolateral thigh flap for knee coverage. In general, the flap receives its perfusion from branches of the lateral circumflex femoral artery lcfa. Sahar, md department of surgery, division of plastic and reconstructive surgery, university of california davis medical center, sacramento, calif. Reconstruction of these defects has been revolutionized. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. A combination of bovie cauterie and bipolar cauterie are used for perforator dissection and the lateral skin paddle incision is left intact until the entire pedicle is harvested. The anterolateral thigh alt flap is a fasciocutaneous flap of the thigh that has not been as popular a choice as the radial forearm flap due to the variable anatomy of the vascular pedicle and the relatively difficult technique of dissection. We describe our clinical experience with this flap in the pediatric population.
A technique for achieving thin perforator flaps sciencecentral. Scip, superficial circumflex iliac artery perforator flap. Clinical application of the anterolateral thigh flap for soft. Radial forearm free flap what is a radial forearm free flap. Reconstruction of throughandthrough cheek defects with. Anterolateral thigh myocutaneous free flap harvest american. However, the anatomic variations decreased its popularity. Sep 03, 2019 lateral thigh flap the lateral thigh free flap is a fascial or fasciocutaneous flap based on the smaller vessels that extend from the profunda femoris system to the skin.
Anterolateral thigh alt free flap for head and neck. These perforating vessels are typically numbered 14 in a superior to inferior direction. Under these conditions, free tissue transferal is the best reconstructive option. The clinical application of anterolateral thigh flap. Its ease of dissection together with the long and reliable pedicle make it extremely suitable as a free skin flap. The aim of this study is to analyze the outcome of free anterolateral thigh flaps for upper extremity soft tissue reconstruction. Its ease of dissection together with the long and reliable pedicle make it extremely suitable as a freeskin flap. Keywords anterolateral thigh flap, surgical technique, anatomic marker. The video presents a versatile free tissue transfer, used to reconstruct a large throughandthrough defect of the cheek and neck. Request pdf sole reconstruction using anterolateral thigh perforator free flaps the goal of sole reconstruction should be functional and aesthetic.
Anterolateral thigh flap harvest based on a single musculocutaneous perforator. Doctors often use this surgery to reconstruct an area in the head and neck. It offers bulk, sensate cover, and has an enormous skin replacement potential. Medial versus lateral approach to harvesting of anterolateral thigh flap. Chung the free anterolateral thigh alt flap is a versatile flap. As a pedicled flap islanded on its vascular pedicle, it is used to reconstruct the inguinal region. Most importantly, the donorsite morbidity is minimal. The expanding role of the anterolateral thigh free. Prelamination of the anterolateral thigh flap with a fibula. Pdf free anterolateral thigh flaps for upper extremity soft. The flap utility and donor site morbidity were evaluated in 126 cases from march 1985 to august 2007. The tissues are elevated until the intramuscular septum between rectus femoris and vastus lateralis is visualized. Pdf the anterolateral thigh free flap for skull base. Oral cavity defect reconstruction using anterolateral.
We report the successful reconstruction of a wide posterior chest wall defect using a free anterolateral thigh myocutaneous. Note preservation of motor branches from the femoral nerve. Oral cavity defect reconstruction using anterolateral thigh free flaps. The anterolateral thigh flap can be used in a variety of ways to reconstruct defects in many areas. Evolution of the anterolateral thigh free flap request pdf. Recent findings the alt free flap is a versatile flap that can be harvested in a chimeric fashion with independent, vascularized skin, muscle, fascia, nerve and bone. Aug, 2017 we searched for perforators and elevated flaps under the fascia with the naked eye. Lateral thigh and anterolateral thigh free tissue transfer. Department of oral and maxillofacial surgery, louisiana state university health science center, shreveport, louisiana, usa.
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