Is Primary Thinning of the Anterolateral Thigh Flap Recommended?

Background:Although primary thinning of the anterolateral thigh (ALT) flap has been successful in Asia, clinical and anatomic studies have demonstrated that this may be inadvisable in Western patients. Recent reports have demonstrated successful thinning of the ALT using smaller flaps. A systematic review was attempted, to assess whether ALT size affects the incidence of vascular compromise after primary thinning. Methods:A systematic review was undertaken to examine the relevant literature. Student t-test was used to compare flaps that did and did not have complications. Fisher exact test was used to compare outcomes of flaps measuring less than and greater than 150 cm2. Results:Eleven articles met the inclusion criteria. Eighty-eight ALT flaps were reported, and vascular compromise was seen in 11 (12.5%). The average size of flaps that demonstrated necrosis was 180.73 cm2; those without necrosis averaged 123.19 cm2 (P = 0.06). Flaps >150 cm2 had a significantly increased rate of compromise (25.93% vs. 6.56%; P < 0.05). Conclusions:A systematic literature review confirms that it is inadvisable to primarily thin large ALT flaps in the Western population. When large ALT flaps are required, primary thinning must be avoided to keep linking vessels intact.

[1]  Masami Saito,et al.  Reconstruction of hand skin defects by microdissected mini anterolataral thigh perforator flaps. , 2008, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[2]  S. Jeng,et al.  Resurfacing with full-thickness skin graft after debulking procedure for bulky flap of the hand. , 2008, The Journal of trauma.

[3]  T. Marianetti,et al.  Anterolateral Thigh Flap for the Reconstruction of Head and Neck Defects: Alternative or Replacement of the Radial Forearm Flap? , 2008, The Journal of craniofacial surgery.

[4]  M. Tedaldi,et al.  Thinned anterolateral thigh cutaneous flap and radial fasciocutaneous forearm flap for reconstruction of oral defects: comparison of donor site morbidity. , 2008, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[5]  Rod J. Rohrich,et al.  Three- and Four-Dimensional Computed Tomographic Angiography and Venography of the Anterolateral Thigh Perforator Flap , 2008, Plastic and reconstructive surgery.

[6]  E. Rodriguez,et al.  Lateral circumflex femoral artery system: warehouse for functional composite free-tissue reconstruction of the lower leg. , 2006, The Journal of trauma.

[7]  F. Wei,et al.  Thin Anterolateral Thigh Perforator Flap Using a Modified Perforator Microdissection Technique and Its Clinical Application for Foot Resurfacing , 2006, Plastic and reconstructive surgery.

[8]  O. Ozkan,et al.  Rationale for reconstruction of large scalp defects using the anterolateral thigh flap: structural and aesthetic outcomes. , 2005, Journal of reconstructive microsurgery.

[9]  J. Choi,et al.  Reconstruction of the Face After Resection of Arteriovenous Malformations Using Anterolateral Thigh Perforator Flap , 2005, The Journal of craniofacial surgery.

[10]  I. Marcoccio,et al.  Hand Reconstruction Using the Thin Anterolateral Thigh Flap , 2005, Plastic and reconstructive surgery.

[11]  Rod J. Rohrich,et al.  Defining Vascular Supply and Territory of Thinned Perforator Flaps: Part I. Anterolateral Thigh Perforator Flap , 2005, Plastic and reconstructive surgery.

[12]  Isao Koshima,et al.  Flow-Through Anterior Thigh Flaps with a Short Pedicle for Reconstruction of Lower Leg and Foot Defects , 2005, Plastic and reconstructive surgery.

[13]  S. Mardini,et al.  Comparison of the Radial Forearm Flap and the Thinned Anterolateral Thigh Cutaneous Flap for Reconstruction of Tongue Defects: An Evaluation of Donor-Site Morbidity , 2004, Plastic and reconstructive surgery.

[14]  F. Wei,et al.  A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. , 2004, British journal of plastic surgery.

[15]  P. Yu.  Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction , 2004, Head & neck.

[16]  S. Mardini,et al.  Reconstruction of the hand and upper limb with free flaps based on musculocutaneous perforators , 2004, Microsurgery.

[17]  S. Jeng,et al.  Free Anterolateral Thigh Adipofascial Perforator Flap , 2003, Plastic and reconstructive surgery.

[18]  I. Koshima,et al.  New Anterolateral Thigh Perforator Flap With a Short Pedicle for Reconstruction of Defects in the Upper Extremities , 2003, Annals of plastic surgery.

[19]  S. Yıldırım,et al.  Soft-Tissue Reconstruction Using a Free Anterolateral Thigh Flap: Experience With 28 Patients , 2003, Annals of plastic surgery.

[20]  Hung-Chi Chen,et al.  Anterolateral thigh flap: an ideal soft tissue flap. , 2003, Clinics in plastic surgery.

[21]  D. Soutar,et al.  To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects. , 2003, British journal of plastic surgery.

[22]  J. Shaw-dunn,et al.  Effects of thinning the anterolateral thigh flap on the blood supply to the skin. , 2003, British journal of plastic surgery.

[23]  S. Yıldırım,et al.  Anterolateral Thigh Flap: Ideal Free Flap Choice for Lower Extremity Soft-Tissue Reconstruction , 2003, Journal of reconstructive microsurgery.

[24]  S. Yıldırım,et al.  Anterolateral Thigh Flap in the Treatment of Postburn Flexion Contractures of the Knee , 2003, Plastic and reconstructive surgery.

[25]  Wei-Chao Huang,et al.  Use of Free Thin Anterolateral Thigh Flaps Combined with Cervicoplasty for Reconstruction of Postburn Anterior Cervical Contractures , 2002, Plastic and reconstructive surgery.

[26]  S. Jeng,et al.  Technique and Strategy in Anterolateral Thigh Perforator Flap Surgery, Based on an Analysis of 15 Complete and Partial Failures in 439 Cases , 2002, Plastic and reconstructive surgery.

[27]  Hung-Chi Chen,et al.  Have We Found an Ideal Soft‐Tissue Flap? An Experience with 672 Anterolateral Thigh Flaps , 2002, Plastic and reconstructive surgery.

[28]  H. Yatsuya,et al.  Role of the anterolateral thigh flap in head and neck reconstruction: advantages of moderate skin and subcutaneous thickness. , 2002, Journal of reconstructive microsurgery.

[29]  R. Gang,et al.  Thin Anterolateral Thigh Free Flap , 2002, Annals of plastic surgery.

[30]  N. Kimura,et al.  Clinical Application of the Free Thin Anterolateral Thigh Flap in 31 Consecutive Patients , 2001, Plastic and reconstructive surgery.

[31]  I. Koshima,et al.  New Multilobe “Accordion” Flaps for Three‐Dimensional Reconstruction of Wide, Full‐Thickness Defects in the Oral Floor , 2000, Annals of plastic surgery.

[32]  Shin-Chen Pan,et al.  Free Anterolateral Thigh Flap for Reconstruction of Head and Neck Defects following Cancer Ablation , 2000, Plastic and reconstructive surgery.

[33]  T. Nakatsuka,et al.  Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. , 1997, Archives of otolaryngology--head & neck surgery.

[34]  M. Ao,et al.  Reconstruction of Posttraumatic Defects of the Foot by Flow‐Through Anterolateral or Anteromedial Thigh Flaps with Preservation of Posterior Tibial Vessels , 1997, Annals of plastic surgery.

[35]  N. Kimura,et al.  Consideration of a Thin Flap as an Entity and Clinical Applications of the Thin Anterolateral Thigh Flap , 1996, Plastic and reconstructive surgery.

[36]  H. Fukuda,et al.  Free Anterolateral Thigh Flaps for Reconstruction of Head and Neck Defects , 1993, Plastic and reconstructive surgery.

[37]  C. Caddy,et al.  The Venous Territories (Venosomes) of the Human Body: Experimental Study and Clinical Implications , 1990, Plastic and reconstructive surgery.