The anterolateral thigh flap lies on the axis of the septum dividing the vastus lateralis and the rectus femoris muscles. In the present case, the surgical scar is less conspicuous and the patient. 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. Evolution of the anterolateral thigh free flap request pdf. The surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Skin defect of forearm repaired by anterolateral thigh.
The pedicled anterolateral thigh island flap for inguinal. The anterolateral thigh alt flap is a versatile soft tissue flap. The anterolateral thigh flap altf, first described by song et al,6 makes use of tissue from a hidden donor site which is concealable in everyday clothing. The single perforatorbased anterolateral thigh flap is a good option for soft tissue reconstruction. Anteromedial thigh perforatorassisted closure of the anterolateral thigh free flap donor site delayed autologous free anterolateral thigh flap failure anterolateral thigh free flap for simultaneous reconstruction of digital extensor tendon and defect of the dorsal hand. In this case report, the tumor and parts of the involved facial muscles and nerve.
Note preservation of motor branches from the femoral nerve. 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. The anterolateral thigh flap can be considered to be one of the workhorses of perforator flaps. Anterolateral free flap alt british association of. The patient gave birth to a healthy baby afterward. Free tissue transfers are sometimes required in the reconstruction of large fullthickness chest wall defects. The anteromedial thigh flap amt lies adjacent to the anterolateral thigh flap alt area and can be used as a backup whenever the alt is not feasible. Hence, contralateral myocutaneous anterolateral thigh alt flap 35. 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. Anterolateral thigh flap is the ideal flap to repair forearm skin defect combined with muscles and bone exposure, which characteristics were anatomical fixing position, high survival rate and good recovery of forearm function and appearance.
Vascularized fascia can be included or the pedicle may be. Free anterolateral thigh perforator flap for sacroiliac. However, designing and raising the alt flap has been traditionally recognized as being difficult, tedious, and technically demanding. Two cases are presented to highlight the technique. A free anterolateral thigh flap was harvested and used to provide soft tissue coverage as well as reconstruction of the palmar arch. Thieme medical publishers 333 seventh avenue, new york, ny 1, usa. Anterolateral thigh alt free flap pocket dentistry. Fasciae and muscles figures 1, 2 the fascia lata is the deep fascia of the thigh, and completely encircles the muscles of the thigh. Management of postpneumonectomy empyema has always been a challenging task. Your thigh will be bandaged for protection and comfort and this will be monitored regularly by nursing staff. Popularity of the anterolateral thigh flap in asia is reflected in the numerous reports from oriental authors. The anterolateral thigh alt flap has been used successfully as a pedicled flap, and has primarily been used in the reconstruction of the perineal, groin, and abdominal wall. Download as an information leaflet pdf anterolateral free flap alt an anterolateral free flap is also known as an alt flap. Chimeric anterolateral thigh flap for total thoracic.
Anterolateral thigh free flap was used in all patients for softtissue augmentation. Vascular anatomy of the anteromedial thigh flap jpras open. The anterolateral thigh flap for soft tissue reconstruction in patients with tongue squamous cell carcinoma xiangjuan tong1, zhangui tang1,2, zhenfeng shan3 and xincheng guo4 abstract background. This method enabled the primary closure of the donor site and provided the positive functional and esthetic outcomes. Sensate anterolateral thigh perforator flap for ischiatic. Twentyfive of these flaps were used for lower extremity reconstruction, 10 were used in the upper extremity, and 9 were used in the head and neck.
Free flap transfer reconstruction in managing tongue. Free flap reconstruction can be an option, even if the patient is pregnant. Secondary salvage thoracic esophageal reconstruction surgery is usually performed with free or pedicled jejunum flaps or colon interposition. Anteromedial thigh perforatorassisted closure of the anterolateral thigh free flap donor site. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome. Anteromedial thigh perforatorassisted closure of the. Anterolateral thigh vastus lateralis flap springerlink. Whereas the medial branch gives off feeders to the rectus femoris muscle and the skin at the medial aspect of the thigh, the lateral branch is the source vessel for septo or myocutaneous perforators to the skin of the anterolateral thigh. Oct 16, 2016 versatility of pedicled anterolateral thigh flap. Additionally, it has a long pedicle with a suitable vessel.
From september 2008 to february 2012, patients receiving alt flap tongue reconstruction were included in the study. Anterolateral thigh myocutaneous free flap harvest american. Clinical experience of 1284 free anterolateral thigh. A broad search was undertaken through the pubmed database using the terms anterolateral thigh free flap and perforator. Advantages of this flap include donor harvesting with a twoteam approach, long length and large caliber of the pedicle, volume variability, minimal donor site morbidity, and the ability to incorporate various tissue components. Anterior lateral thigh osteomyocutaneous free flap. Fig 2 a an anterolateral thigh alt combined flap of vastus lateralis vl and rectus femoris rf muscles was designed for a 70yearold man with a history of tuberculosis who presented with recurrent empyema after pneumonectomy, as demonstrated in the b the chest roentgenogram which shows a large cavity in the left chest. Free anterolateral thigh flap for reconstruction of upper aerodigestive tract defects. However, scars are not eliminated, just moved to a different location, the thigh, that can for some patients be of great sexual value. Case note analysis was performed to determine demographic and perioperative factors, and complications and outcomes. Free anterolateral thigh flap guang yang and kevin c. Reconstruction of large groin defect after dfsp resection was performed by splitskin paddle anterolateral thigh flap instead of skin graft considering that the patient was a 29yearold woman.
Perforators can be marked with a pencil doppler to help design the outline of the flap. 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. Vascularized fascia can be included or the pedicle may be harvested as a flow. Of these three flaps, the anterolateral thigh flap became most popular, especially in head and neck reconstruction. The anterolateral thigh free flap is described in terms of its surgical anatomy, techniques of elevation and its application in seven cases of trauma to the hand. Free anterolateral thigh flap was transferred to reconstruct the tongue defect, successfully. Anterolateral thigh perforator free flap pocket dentistry. The interpolated anterolateral thigh flap islanded on its vascular pedicle, is a durable local flap option for large skin and soft tissue defects caused by inguinal block dissections.
Request pdf anterolateral thigh perforator flap the anterolateral thigh alt perforator flap is based on the septocutaneous or musculocutaneous perforators from the lateral circumflex femoral. An anterolateral thigh chimeric flap for dynamic facial. Patients undergoing alt flap were compared with those undergoing similar surgery with radial forearm flap rff. Functional tongue reconstruction with the anterolateral. Chung the free anterolateral thigh alt flap is a versatile flap. Pdf free anterolateral thigh flaps for upper extremity soft. Reduced anterolateral thigh flap donorsite morbidity. More recently, the altf has gained popularity in the united states and is quickly becoming a key tool for microvascular reconstruction. Flap refinements that have potential applications for hand surgery are. Preexpansion of the alt flap allows primary donor site closure, thus avoiding not only the unsightly.
There has been very little written about the variations of the pedicle vessels and in this paper we describe the variations we found in patients. The lateral edge of the flap can be incised down to the muscle and elevated subfascially from lateral to. The anterolateral thigh flap was first described by dr. Simultaneous anterolateral thigh flap and temporalis.
The anterolateral thigh alt perforator flap for phalloplasty is gaining popularity because it avoids the wellknown scars of the radial forearm flap. The anterolateral thigh flap for complicated abdominal. Apr 11, 2018 the surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Bilateral anatomic variation of anterolateral thigh flap in.
Contralateral sandwich myocutaneous anterolateral thigh flap. Original article has the anterolateral thigh flap replaced. By this submuscular transposition, an additional 5 cm length of the flap pedicle was gained. A true chimeric flap can also be elevated by combining the. Additionally, it has a long pedicle with a suitable vessel diameter, which is able to anastomose with the recipient vessels beyond the injured. Hemiglossectomy and ipsilateral neck dissection was performed. The anterolateral thigh flap altf, first described by song et al 2 in 1984, has become a popular donor site for head and neck reconstruction in europe and asia. Sacks, md, neha goel, bs, martina ayad, bs, and roman j. The flap is outlined on the axis of the anterior superior iliac spine and the lateral patella.
Functional tongue reconstruction with the anterolateral thigh. We present a case of a total thoracic esophageal reconstruction with an externally monitored chimeric anterolateral thigh flap, extending from the cervical esophagus to the retrosternal gastroplasty remnant. Between may 2011 and september 20, five patients underwent transfer of a sensate pedicled anterolateral thigh flap, by an intermuscular passageway through the upper thigh, to reach the. It can be harvested as a fasciocutaneous or myocutaneous flap. Jan 30, 2017 the anterolateral thigh alt free flap is frequently used in the head and neck. Perforator variability in the anterolateral thigh free flap. Abstractthe anterolateral thigh flap has been used for coverage of defects in the foot and ankle for years.
Aesthetic and functional advantages of the anterolateral thigh flap in reconstruction of tumorrelated scalp defects. It is one of the ways of replacing tissue in the head and neck. This type of flap has been frequently used in head and neck reconstruction 3,4. Since its introduction in 1984 by song et al, 1 the anterolateral thigh flap has gained widespread popularity, especially in asian countries, where it has replaced the radial forearm flap as being the workhorse in head and neck surgery. Literature published on the amt flap is limited, and the vascular anatomy of the amt flap is not well understood. So far, this flap has not been described for resurfacing such defects. The anterolateral thigh flap is ideally suited for reconstruction in the oral and maxillofacial region.
Anterolateral thigh flap for skull base reconstruction. The anterolateral thigh alt flap has gained popularity in reconstructive surgery in recent years as its advantages have come to be widely recognized. In 1984, song and coworkers described the thigh as a donor site for three new flaps, which they raised from its posterior, anteromedial, and anterolateral aspects 361. Aug 11, 2009 the anterolateral thigh alt flap is a versatile soft tissue flap. 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. To minimize the risk of viscera exposure in case of free flap complications, we describe a twostage procedure using an anterolateral thigh flap. Department of oral and maxillofacial surgery, louisiana state university health science center, shreveport, louisiana, usa. Pdf free anterolateral thigh flap for reconstruction of.
Of the former group, additional soft tissue was harvested to allow for correction of both. The free anterolateral thigh flap not only reconstructed the unique soft tissue envelope of the hand but also restored functional vascular anatomy by reconstituting the interrupted superficial palmar arch. Anterolateral thigh alt free flap surgery this leaflet has been written to help your understanding of anterolateral free flap surgery. The flap is pliable, can be thinned down7and is potentially sensate. The particular advantages of this free flap for reconstructing a variety of hand defects are demonstrated. Contralateral sandwich myocutaneous anterolateral thigh. Free anterolateral thigh flap for extremity reconstruction. We could obtain sufficient flap volume using the anterolateral thigh flap for tongue reconstruction. Skoracki, md otolaryngologyhead and neck surgery 2009 140. If you have any other questions that the leaflet does not answer or would. Pdf free anterolateral thigh flaps for upper extremity.
We report the utilization of the sensate pedicled anterolateral thigh perforator flap for reconstruction of ischiatic sores in meningomyelocele patients. Anterolateral thigh flap, external fixation, dermatoplasty. Clarification of the vascular anatomy will be useful for safe and efficient planning and raising of the amt flap. Luo s, raffoul w, luo j, luo l, gao j, chen l, et al. Anterior lateral thigh osteomyocutaneous free flap reconstruction in the head and neck. A method of reconstructing soft tissue defects to various regions of the body.
Free anterolateral thigh combined flap for chronic. We report the senior authors experience over a fiveyear period with the use of the alt flap. The anterolateral thigh flap is an extremely versatile extremity flap since its moderately thick skin and large potential muscle bulk can be independently tailored to provide ideal tissue matches for this heterogeneous group of defects. Free anterolateral thigh flaps for upper extremity soft.
Three flaps were fasciocutaneous and 2 flaps were buried deepithelialized fatfascia flaps. Immediate reconstruction should be performed after wide resection of tumour. We found bilateral anatomic variation in the main cutaneous branch of the descendent branch of the lateral circumflex femoral artery between. Preexpanded anterolateral thigh perforator flap for. The anterolateral thigh osteomyocutaneous femur bone flap robert m. It can provide abundant soft tissue coverage and minimal donor site morbidity. Jan 18, 2015 chapter 61 anterolateral thigh perforator free flap. Subsequent descriptions have since detailed its widespread applications, with the largest series to date published by wei and colleagues in 2002, in which they reported their. Advancing education, research, and quality of care for the head and neck oncology patient. Anterolateral free flap alt british association of oral. Anterolateral thigh perforator flap plastic surgery key. It is one of the most commonly used flaps for reconstruction of head and neck defects after ablation. We report our experience with our first 44 consecutive anterolateral thigh flaps, which were used for a variety of softtissue deficits. Twostage free anterolateral thigh flap in the management of.
More recently, the altf has gained popularity in the united states and is quickly becoming. Anterolateral thigh flap harvest based on a single musculocutaneous perforator. Reduced anterolateral thigh flap donorsite morbidity using incisional. Surgery remains the first choice of treatment for tongue cancer. It can be used for large soft tissue defects both extraorally and intraorally figs. Local flaps or free muscle flaps are options for recalcitrant cases when traditional therapeutic attempts fail. The anterolateral thigh free flap was first described by song et al. Material and methods we attempted to raise anterolateral thigh flaps in patients. Brody md department of otorhinolaryngology head and neck surgery, hospital of the university of pennsylvania, philadelphia, pennsylvania. The descending branch of the lfca is the most common blood supply of the anterolateral thigh alt. We performed an observational retrospective case series study in 11 patients and an observational prospective study in 7 cadavers to confirm our findings. The anterolateral thigh flap for complicated abdominal wall reconstruction after giant incisional hernia repair. Anterolateral thigh flap an overview sciencedirect topics. The anterolateral thigh alt flap is the workhorse flap for abdominal wall reconstruction.
A tertiary referral center experience from india duration. The anterolateral thigh alt flap is now considered a workhorse for head and neck reconstruction in many centers. Anterolateral thigh free flap for complex soft tissue hand. The anterolateral thigh free flap for skull base reconstruction matthew m. In a clinical study of 115 flap raising procedures at the anterolateral thigh, the descending branch was. A retrospective study was conducted to evaluate the advantages of anterolateral thigh alt flap in tongue reconstruction. If you have any other questions that the leaflet does not answer or would like a further explanation, please ask your surgeon or cns. This report presents 2 patients with chronic postpneumonectomy empyema who were treated with an anterolateral thigh combined flap consisting of vastus lateralis and rectus femoris muscles.
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