A retrospective clinical study of 41 cases of distally based anterolateral thigh flaps based on a new classification

doi:10.13418/j.issn.1001-165x.2024.5.10

PDF(4969 KB)

Chinese Journal of Clinical Anatomy ›› 2024, Vol. 42 ›› Issue (5) : 549-554. DOI: 10.13418/j.issn.1001-165x.2024.5.10

A retrospective clinical study of 41 cases of distally based anterolateral thigh flaps based on a new classification

Du Qingyan¹, Zang Mengqing¹, Zhu Shan¹, Tong Dedi², Li Shanshan¹, Chen Zixiang¹, Liu Yuanbo¹*

Author information +

History +

Abstract

Objective To investigate the characteristics and surgical attentions of the distally-based anterolateral thigh (dALT) flap in order to improve the success rate of operation. Methods A retrospective analysis of 41 patients treated from November 2010 to February 2023 to repair soft tissue defects around the knee joint with dALT flaps. The dALT flap was classified into type I, type II, or type III based on the origin (the descending, oblique, or transverse branch) of the chosen perforator. The vascular pedicle length, repaired defect location, and flap outcome of different types were compared. Results The type Ⅰ flap had a shorter vascular pedicle that primarily reached closer regions (distal third of the thigh and anterior/lateral knee) (62.5%,15/24). Type Ⅱ and type Ⅲ flaps had longer pedicles that mostly reached more distal regions (medial/posterior knee and proximal third of the leg) (84.7%, 11/13; 100.0%, 4/4). However, the type Ⅲ flaps had higher complication rate (50.0%) and flap necrosis rate (25.0%). Conclusions To achieve more desirable outcomes using the dALT flap, preoperative assessment of vascular pedicle length and proper intraoperative maneuvers that avoid compromising the reverse blood circulation are necessary.

Key words

Anterolateral thigh flap / / / Perforator flap / / / Retrograde flap / / / Soft-tissue reconstruction / Lower extremity

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

Du Qingyan, Zang Mengqing, Zhu Shan, Tong Dedi, Li Shanshan, Chen Zixiang, Liu Yuanbo. A retrospective clinical study of 41 cases of distally based anterolateral thigh flaps based on a new classification[J]. Chinese Journal of Clinical Anatomy. 2024, 42(5): 549-554 https://doi.org/10.13418/j.issn.1001-165x.2024.5.10

References

[1] Chen CY, Hsieh CH, Kuo YR, et al. An anterolateral thigh perforator flap from the ipsilateral thigh for soft-tissue reconstruction around the knee[J]. Plast Reconstr Surg, 2007, 120(2):470-473. DOI: 10.1097/01.prs.0000267432.03348.97.
[2] Ismail HA, El-Bassiony LE. Reverse-flow anterolateral thigh perforator: An ad hoc flap for severe post-burn knee contracture[J]. Ann Burns Fire Disasters, 2016, 29(1):71-75.
[3] Daigeler A, Drucke D, Tatar K, et al. The pedicled gastrocnemius muscle flap: A review of 218 cases[J]. Plast Reconstr Surg, 2009, 123(1):250-257. DOI: 10.1097/PRS.0b013e3181904e2e.
[4] 张功林,葛宝丰,姜世平,等.逆行股前外侧岛状皮瓣和肌皮瓣移植术[J].中华医学杂志, 1990, 70(12):676-678.
[5] Gravvanis AI, Iconomou TG, Panayotou PN, et al. Medial gastrocnemius muscle flap versus distally based anterolateral thigh flap: Conservative or modern approach to the exposed knee joint?[J] Plast Reconstr Surg, 2005,116(1):932-934. DOI: 10.1097/01.prs.0000180888.41899.a8.
[6] Lin CH, Zelken J, Hsu CC, et al. The distally based, venous supercharged anterolateral thigh flap[J]. Microsurgery, 2016,36(1):20-28. DOI: 10.1002/micr.22380.
[7] Liu T-Y, Jeng S-F, Yang JC-S, et al. Reconstruction of the skin defect of the knee using a reverse anterolateral thigh island flap: Cases report[J]. Ann Plast Surg, 2010,64(2):198-201. DOI:10.1097/SAP.0b013e31819bd6f7.
[8] Heo C, Eun S, Bae R, et al. Distally based anterolateral-thigh (alt) flap with the aid of multidetector computed tomography[J]. J Plast Reconstr Aesthet Surg, 2010,63(5):e465-e468. DOI:10.1016/j.bjps.2009.08.009.
[9] Moyer HR, LOSKEN A. Predicting mastectomy skin flap necrosis with indocyanine green angiography: the gray area defined[J]. Plast Reconstr Surg, 2012, 129(5): 1043-1048. DOI: 10.1097/PRS.0b013e31824a2b02.
[10]Shieh SJ, Chiu HY, Yu JC, et al. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation[J]. Plast Reconstr Surg, 2000,105(7):2349-57. DOI: 10.1097/00006534-200006000-00006.
[11]Pan SC, Yu JC, Shieh SJ, et al. Distally based anterolateral thigh flap: An anatomic and clinical study[J]. Plast Reconstr Surg, 2004,114(7):1768-1775. DOI: 10.1097/01.PRS.0000142416.91524.4C.

[12]Demirseren ME, Efendioglu K, Demiralp CO, et al. Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg[J]. J Plast Reconstr Aesthet Surg,2011,64(12):1613-1620. DOI:10.1016/j.bjps.2011.06.047.

[13]Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: The oblique branch of the lateral circumflex femoral artery[J]. Plast Reconstr Surg, 2009,123(2):571-577. DOI: 10.1097/PRS.0b013e318195658f.
[14]肖春林,赵敏,史柏娜,等.改良逆行股前外侧皮瓣修复小腿中上段皮肤软组织缺损[J].中国临床解剖学杂志,2014,32(06):732-734. DOI:10.13418/j.issn.1001-165x.2014.06.025
[15]Lin RYC, Chien WH. Experiences in harvesting type ii distally based anterolateral thigh flaps[J]. Plast Reconstr Surg, 2006,118(1):282-284. DOI: 10.1097/01.prs.0000222243.18349.52.
[16]Cotrufo S, Hart A. A note of caution on the use of the distally based anterolateral thigh flap: Anatomical evidence[J]. Plast Reconstr Surg, 2010,125(1):30e-31e. DOI:10.1097/PRS.0b013e3181c2a40f.
[17]Lin SD, Lai CS, Chiu CC. Venous drainage in the reverse forearm flap[J]. Plast Reconstr Surg, 1984,74(4):508-512. DOI: 10.1097/00006534-198410000-00008.
[18]Ding Q, Zang M, Liu Y. A new recipient artery for reconstruction of soft-tissue defects in the lower limb with a free anterolateral thigh flap: The reversed descending branch of the lateral femoral circumflex artery[J]. Plast Reconstr Surg, 2014,133(6):892e-893e. DOI:10.1097/PRS.0000000000000206.
[19]Chien WH, Chen IC, Tan TS, et al. Salvage of knee joint tumor prosthesis using turnover reverse-flow descending branch of lateral circumflex femoral artery as recipient vessel for the free alt flap: A case report[J]. J Reconstr Microsurg, 2007, 23(8):505-509. DOI: 10.1055/s-2007-992334.
[20]Gao SH, Feng SM, Chen C, et al. A new recipient artery for reconstruction of soft-tissue defects in the lower limb with a free anterolateral thigh flap: The reversed descending branch of the lateral femoral circumflex artery[J]. Plast Reconstr Surg, 2012,130(5):1059-1065. DOI:10.1097/PRS.0b013e318267d3a3.