Abstract
Background The distally based anterolateral thigh (ALT) flap is an interesting reconstructive
solution for complex soft tissue defects of the knee. In spite of a low donor site
morbidity and wide covering surface as well as arch of rotation, it has never gained
popularity among reconstructive surgeons. Venous congestion and difficult flap dissection
in the presence of a variable anatomy of the vascular pedicle are the possible reasons.
Methods An anatomical study of 15 cadaver legs was performed to further clarify the blood
supply of the distally based ALT. Our early experience with the use of preoperative
angiography and a safe flap design modification that avoids distal intramuscular skeletonization
of the vascular pedicle and includes a subcutaneous strip ranging from the distal
end of the flap to the pivot point is presented.
Results The distally based ALT presents a constant and reliable retrograde vascular contribution
from the superior genicular artery. Preoperative angiography reliably identified and
avoided critical Shieh Type II pedicled flaps. The preservation of a subcutaneous
strip ranging from the distal flap end to the upper knee was associated with the absence
of venous congestion in a short case series.
Conclusions Preoperative angiography and a flap design modification are proposed to allow the
safe transfer of the distally based ALT to reconstruct soft tissue defects of the
knee.
Keywords
anterolateral thigh (ALT) - reverse flaps - distally based anterolateral thigh flap
- venous congestion - anatomic study
