Anterolateral thigh flap reconstruction of full thickness. The anterolateral thigh flap is a septocutaneous artery flap based on the septocutaneous or muscle perforators of the lateral circumflex femoral system. Most importantly, the donorsite morbidity is minimal. Based on a long pedicle from the lateral femoral circumflex artery, the flap is versatile and reliable. The anterolateral thigh alt flap has gained popularity in reconstructive surgery in recent years as its advantages have come to be widely recognized. To understand the vascular anatomy of the anterolateral thigh alt free flap. Before long the free anterolateral thigh flap has been one of the dominating reconstructive options for the lower. Original article risk factors of free anterolateral thigh. The anterolateral thigh flap, first described by song, is one of the septocutaneous flaps in the thigh. Chapter 61 anterolateral thigh perforator free flap. The qualities of the ideal soft tissue free flap for head and neck. The free anterolateral thigh alt flap is a versatile flap.
Free tissue transfers are sometimes required in the reconstruction of large fullthickness chest wall defects. It can provide abundant soft tissue coverage and minimal donor site morbidity. 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. This technique enables both vascular and soft tissue reconstructions simultaneously with minimal donor site problems. To minimize the risk of viscera exposure in case of free flap complications, we describe a twostage procedure using an anterolateral thigh flap. An adequate sized flap should be harvested to correct the intraoral and skin defect. Jan 18, 2015 chapter 61 anterolateral thigh perforator free flap. If you have any other questions that the leaflet does not answer or would like a further explanation, please ask your surgeon or. Download as an information leaflet pdf anterolateral free flap alt an anterolateral free flap is also known as an alt flap. Free anterolateral thigh flap for coverage of scalp large. 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. The lateral edge of the flap can be incised down to the muscle and elevated subfascially from lateral to medial, taking. The flap is supplied in most cases by perforators from the descending branch of the lateral circumflex femoral artery lcfa.
Anteromedial thigh perforatorassisted closure of the. A true chimeric flap can also be elevated by combining the. 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. By adapting freestyle flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator. 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. Firstly, flap selection is an important consideration. By adapting freestyle flap concepts, such as preoperative mapping of the. Pdf free anterolateral thigh flaps for upper extremity soft tissue. Chung the free anterolateral thigh alt flap is a versatile flap. Flap design the flap should ideally have been elevated at the same time as completion of resection of the primary and the neck dissection. Free deepithelialized anterolateral thigh myocutaneous flaps. From a technical standpoint, free flap reconstruction in the elderly presents certain unique challenges. Free anterolateral thigh flap is considered by most surgeons to be the proper choice for restoring scalp defect in the adult population. Free anterolateral thigh flap harvesting from paralytic limbs.
It supplies a large area of skin on the anterolateral aspect of the thigh. The vascular pedicle should be followed proximally to its origin to obtain maximal pedicle length. Sep 28, 2017 the anterolateral thigh alt flap allows for healthy, reliable, vascularized, softtissue coverage of extremity or axial defects of traumatic or acquired deformities. Twostage free anterolateral thigh flap in the management of. Little has been reported about the variations in its vascular anatomy and its application for head and neck reconstruction. The alt free flap is a versatile, reliable flap that should be considered a firstline option for skull base reconstruction. Department of oral and maxillofacial surgery, louisiana state university health science center, shreveport, louisiana, usa. A thin layer of fat below scarpas fascia is preserved with the deep fascia to create a thin fat and fascial flap. The anterolateral thigh alt free flap is frequently used in the head and neck. Since november 1985 we have transferred 32 anterolateral.
Free anterolateral thigh combined flap for chronic. Subacute reconstruction using flap transfer for complex. Evolution of the anterolateral thigh free flap request pdf. Anterolateral thigh perforator flap plastic surgery key. Free anterolateral thigh flaps for reconstruction of head and. 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. Pdf free anterolateral thigh flap for reconstruction of. However, in the pediatric burn population with scalp large defects, the use of this flap has not been well described. The main nutrient vessel of the anterolateral thigh flap is the perforator originating from the descending branch of the lateral circumflex femoral artery lcfa. With a twoteam approach the oncologic surgeon therefore resects the. Anterolateral free flap alt british association of.
Many types of skin flaps can be used as an option for wound coverage 1, 2. Request pdf anterolateral thigh perforator free flap this chapter deals with a method of reconstructing soft tissue defects to various regions of the body. Free anterolateral thigh versus vastus lateralis muscle flap. May 11, 20 the aim of the present study is to assess functional outcomes after hemiglossectomy and microvascular reconstruction. We report the senior authors experience over a fiveyear period with the use of the alt flap. Anterolateral thigh alt free flap pocket dentistry. The anterolateral thigh free flap is harvested in the standard fashion with the following considerations. Anterolateral thigh alt free flap for head and neck. Reconstruction with the anterolateral thigh alt flap was first described by song and colleagues as a septocutaneous flap 2. Pdf versatility of the free anterolateral thigh flap. Reconstruction of dorsal foot defects with free anterolateral thigh flap. Twelve patients were reconstructed using a free radial forearm flap and 14 with an anterolateral thigh flap.
Anterolateral thigh flap harvest based on a single musculocutaneous perforator. In a clinical study of 115 flapraising procedures at the anterolateral thigh, the descending branch was. The mission of the ahns is to advance education, research, and quality of care for the head and neck oncology patient. The expanding role of the anterolateral thigh free flap in h. 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 flap for reconstruction of upper aerodigestive tract defects.
A practical guide to the use of the anterolateral thigh flap. B two pedicled anterolateral thighs outlined on the thighs. Background to compare free thin anterolateral thigh alt flap with free radial forearm frf flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin alt flap. Anterolateral thigh flap an overview sciencedirect topics.
Therefore, when unfavorable perforator anatomy is encountered in the alt flap territory, the amt can usually be raised. Free anterolateral thigh flaps for upper extremity soft tissue. Note preservation of motor branches from the femoral nerve. Operative time is minimized by performing a simultaneous twoteam approach to resection and reconstruction, and by harvesting 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. Risk factors of free anterolateral thigh flap failure for reconstruction. Anterolateral thigh alt free flap surgery this leaflet has been written to help your understanding of anterolateral free flap surgery. In recent practice, we have selected three workhorse free flaps for head and neck reconstruction. High velocity injuries have traditionally been covered with free muscle flaps.
In a clinical study of 115 flap raising procedures at the anterolateral thigh, the descending branch was. Clinical experience and surgical anatomy of 32 free anterolateral. In our insti tution the free alt perforator flap has become a work. A broad search was undertaken through the pubmed database using the terms anterolateral thigh free flap and perforator. The clinical application of anterolateral thigh flap. The versatile anterolateral thigh flap journal of plastic. A method of reconstructing soft tissue defects to various regions of the body. Free anterolateral thigh flap guang yang and kevin c. Anterolateral thigh perforator free flap pocket dentistry. Another example of alt flap harvest, starting with the anterior skin incision and. It is one of the ways of replacing tissue in the head and neck. Objective to elucidate the advantages and disadvantages of the anterolateral thigh flap altf for pharyngoesophageal reconstruction, we assessed this donor site and compared it with the radial forearm free flap rfff.
Free tissue transfer for the repair of complex defects is a mainstay of modern reconstructive surgery 1. Free deepithelialized anterolateral thigh dalt flaps have been used for treatment of chronic intractable empyema with bronchopleural fistula at chang gung memorial hospital since 1997. 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 allows for healthy, reliable, vascularized, softtissue coverage of extremity or axial defects of traumatic or acquired deformities. Twelve patients with chronic empyema were treated at chang gung memorial hospital from january 1997 to january 2001. Anterolateral thigh perforator free flap request pdf.
The anterolateral thigh alt and vastus lateralis vl flaps are popular options for free tissue transfer in lower extremity reconstruction. 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. Functional results of microvascular reconstruction after. Anterolateral thigh myocutaneous free flap harvest american. 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 flap is ideally suited for reconstruction in the oral and maxillofacial region. Here, we describe a case in which we reconstruct a 14 cm.
Free anterolateral thigh perforator flap for head and neck cancer resection in a nonagenarian 3 postoperatively. The position of the nerve to vastus lateralis is variable with respect to the vascular pedicle. The aim of this study is to analyze the outcome of free anterolateral thigh flaps for upper extremity soft tissue reconstruction. However, the anatomic variations decreased its popularity. Celik n, wei fc, lin ch, cheng mh, chen hc, jeng sf, kuo yr 2002 technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Pdf the anterolateral thigh flap can provide a large skin paddle nourished by a. If you have any other questions that the leaflet does not answer or would like a further explanation, please ask your surgeon or cns. The thigh has been called the reconstructive warehouse.
Apr 17, 2015 reconstruction of dorsal foot defects with free anterolateral thigh flap. Twentysix patients underwent primary tongue microvascular reconstruction after hemiglossectomy. Jan 30, 2017 the anterolateral thigh alt free flap is frequently used in the head and neck. Anterolateral free flap alt british association of oral. Additionally, it has a long pedicle with a suitable vessel diameter, which is able to anastomose with the recipient vessels beyond the injured area. Vascular anatomy of anterolateral thigh flap malhotra. It can be used for large soft tissue defects both extraorally and intraorally figs. Jan 10, 2018 anterolateral thigh free flap elevation. Anterolateral thigh perforator free flap elevation youtube.
We sought to evaluate the utility of the anterolateral thigh flap alt flap as a primary choice in reconstructing traumatic injuries in western patients. Place the patient in the supine position, which allows for flap harvest and typically. The aim of the present study is to assess functional outcomes after hemiglossectomy and microvascular reconstruction. The anterolateral thigh flap can provide a large skin paddle nourished by a long and largecaliber pedicle and can be harvested by twoteam work. Free anterolateral thigh flap harvesting from paralytic limbs in postpolio syndrome chihhsuan changchien, weichen chen and yumin su department of plastic and reconstructive surgery, chiayi christian hospital, chiayi city, taiwan abstract we report two cases of poliomyelitis in which an anterolateral thigh myocutaneous free flap was. The anterolateral thigh free flap is a useful resource for the coverage of defects of different etiologies both in the upper limbs and in the lower limbs since its versatility allows. Pdf the clinical application of anterolateral thigh flap. Perforator variability in the anterolateral thigh free flap. Material and methods the clinicopathologic data of 46 tongue carcinoma cases hospitalized from december 2009 to april 2014 were obtained from. Free anterolateral thigh perforator flap for head and neck. Breast reconstruction with free anterolateral thigh flap ranjit raje, ramesh chepauk, kanti shetty, rajendra prasad j. Hand salvage and reconstruction following trauma and oncologic resection often dictates the use of.
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