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Handchir Mikrochir Plast Chir 2009; 41(4): 193-202
DOI: 10.1055/s-0029-1220916
Übersichtsarbeit

© Georg Thieme Verlag KG Stuttgart · New York

The Versatility of the Anterolateral Thigh Flap in Lower Extremity Reconstruction

Die Vielseitigkeit der anterolateralen Oberschenkel-Lappenplastik in der Rekonstruktion der unteren ExtremitätJ. H. Dayan 1 , C. -H. Lin 1 , F. C. Wei 1
  • 1Department of Plastic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Publication History

eingereicht 26.3.2009

akzeptiert 16.4.2009

Publication Date:
21 July 2009 (online)

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Abstract

The anterolateral thigh flap (ALT) has emerged as one of the major workhorses in lower extremity reconstruction. As knowledge of the local anatomy and familiarity with intramuscular dissection has grown, so has the multitude of applications of the ALT flap. Its abundance of tissue, long and large caliber pedicle, minimal donor site morbidity, and the ability to use a two-team approach affords the surgeon with a reliable reconstructive option. The variety of tissues that may be harvested from the lateral circumflex femoral axis can provide like-with-like tissue replacement for most components in the lower extremity. Some of the creative applications successfully reported include flow-through flap for revascularization, vascularized fascia lata for single-stage tendon reconstruction, functional muscle transfer, sensate flaps, and chimeric flaps for extensive composite defects. The following article summarizes our technique for reliable flap harvest, a thorough review of both the benefits and limitations of the anterolateral thigh flap, and a review of its many applications reported in the international community.

Zusammenfassung

Die anterolaterale Oberschenkel-Lappenplastik („ALT Flap”) hat sich in den letzten Jahren zu einem Arbeitspferd in der Unterschenkelrekonstruktion entwickelt. Mit den Erfahrungen im Umgang mit der Anatomie bei der Hebung und intramuskulären Präparation der Perforans-Gefäße wurde auch eine Vielzahl von verschiedenen Anwendungen der Lappenplastik entwickelt. Die Menge an Gewebe, der lange Gefäßstiel mit großem Kaliber, der geringe Hebedefekt und die Möglichkeit in zwei Teams zu arbeiten, machen die Lappenplastik für den rekonstruktiven Chirurgen zu einer attraktiven und zuverlässigen Option. Die Vielzahl der Gewebetypen, die von der A. circumflexa femoris lateralis versorgt werden, erlaubt eine Rekonstruktion der unteren Extremität dem Grundsatz des „Ähnliches mit Ähnlichem”-Ersatzes folgend für die meisten Gewebekomponenten. Zu diesen kreativen Anwendungen zählt die Durchfluss-Lappenplastik zur Revaskularisation des Unterschenkels, vaskularisierte Fascia lata für eine einzeitige Sehnenrekonstruktion, der funktionelle Muskeltransfer, sensible Lappenplastiken und chimäre Lappenplastiken bei ausgedehnten Defekten. Die vorliegende Arbeit stellt unsere Operationstechnik zur zuverlässigen Hebung der Lappenplastik dar und gibt eine Übersicht der Möglichkeiten und Grenzen der anterolateralen Oberschenkel-Lappenplastik sowie eine Literaturübersicht zur Vielzahl der Anwendungen.

Key words

microsurgery - fascia flap - skin flap - muscle flap - lower limb reconstruction - flow-through flap

Schlüsselwörter

Mikrochirurgie - Faszienlappenplastik - Hautlappenplastik - Muskellappenplastik - untere Extremität - Perforans-Lappenplastiken

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Korrespondenzadresse

F. C. WeiMD, F. A. C. S 

Department of Plastic Surgery

Chang Gung Memorial Hospital

College of Medicine

Chang Gung University

5 Fu-Shing Street

Taoyuan

Taiwan

R.O.C.

Phone: +886/3/328 12 00 ext. 3660

Fax: +886/3/328 72 60

Email: fcw2007@cgmh.org.tw