Repeated Elevation of the Anterolateral Thigh Flap for Lower Extremity Orthopedic Trauma Does Not Affect Flap Viability

Abstract

Background The anterolateral thigh (ALT) flap has a key role regarding limb salvage and has facilitated the preservation of function and esthetics in lower extremity reconstruction. The purpose of this study is to review the advantages of the ALT flap when used early in the reconstruction of the trauma patient; specifically, its long-term viability when ALT flap reconstruction is followed by recurrent flap elevation performed to allow a variety of sequential orthopedic operations including washout, antimicrobial disc placement, and reinstrumentation.

Methods A retrospective analysis was performed to review all ALT flaps performed by the authors from January 2009 to October 2012 at the Orlando Regional Medical Center. A total of 69 patients with an average age of 38 years were included in the study leading to a total of 69 ALT flaps indicated for traumatic orthopedic wounds. Out of these, 29 flaps were elevated at least once leading to a total of 49 flap elevations.

Results The median number of days to flap elevation was 117 with a minimum of 1 day and a maximum of 540 days. A total of 42% flaps were elevated at least once after initial placement for reinstrumentation, washout, or antibiotic disk placement. Overall, 52% of the flaps were lifted once, 34% were lifted twice, and 14% were lifted more than thrice. There is no statistically significant difference in the complication rate between elevating the flap compared with primary ALT placement.

Conclusion We conclude, therefore, there is no elevated risk to long-term viability by elevating the ALT flap. This combined with the ease of elevation makes it a safe procedure to be performed as needed for access to the deep tissues.

Keywords

ALT - flap elevation - lower extremity trauma

Note

This research has not been presented at a meeting as of yet.

• References

• 1 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37 (2) 149-159
• 2 Koshima I, Yamamoto H, Hosoda M, Moriguchi T, Orita Y, Nagayama H. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle. Plast Reconstr Surg 1993; 92 (3) 411-420
• 3 Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 1993; 92 (3) 421-428 , discussion 429–430
• 4 Kimata Y, Uchiyama K, Ebihara S , et al. Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Arch Otolaryngol Head Neck Surg 1997; 123 (12) 1325-1331
• 5 Yildirim S, Gideroğlu K, Aköz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg 2003; 19 (4) 225-233
• 6 Ozkan O, Coşkunfirat OK, Ozgentaş HE. The use of free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities. Ann Plast Surg 2004; 53 (5) 455-461
• 7 Song JW, Ben-Nakhi M, Hong JP. Reconstruction of lower extremity with perforator free flaps by free style approach in pediatric patients. J Reconstr Microsurg 2012; 28 (9) 589-594
• 8 Park JE, Rodriguez ED, Bluebond-Langer R , et al. The anterolateral thigh flap is highly effective for reconstruction of complex lower extremity trauma. J Trauma 2007; 62 (1) 162-165
• 9 Rodriguez ED, Rosson GD, Bluebond-Langner R , et al. The utility of the anterolateral thigh donor site in reconstructing the United States trauma patient. J Trauma 2007; 62 (4) 892-897
• 10 Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 1998; 102 (5) 1517-1523
• 11 Xu DC, Zhong SZ, Kong JM , et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg 1988; 82 (2) 305-310
• 12 Collins J, Ayeni O, Thoma A. A systematic review of anterolateral thigh flap donor site morbidity. Can J Plast Surg 2012; 20 (1) 17-23
• 13 Pollak AN, McCarthy ML, Burgess AR ; The Lower Extremity Assessment Project (LEAP) Study Group. Short-term wound complications after application of flaps for coverage of traumatic soft-tissue defects about the tibia. J Bone Joint Surg Am 2000; 82-A (12) 1681-1691
• 14 Calderon W, Chang N, Mathes SJ. Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg 1986; 77 (5) 785-794
• 15 Hong JP, Shin HW, Kim JJ, Wei FC, Chung YK. The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity. Plast Reconstr Surg 2005; 115 (1) 142-147
• 16 Guerra AB, Gill PS, Trahan CG , et al. Comparison of bacterial inoculation and transcutaneous oxygen tension in the rabbit S1 perforator and latissimus dorsi musculocutaneous flaps. J Reconstr Microsurg 2005; 21 (2) 137-143
• 17 Salgado CJ, Mardini S, Jamali AA, Ortiz J, Gonzales R, Chen HC. Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects. Plast Reconstr Surg 2006; 118 (6) 1401-1411
• 18 Lee JC, St-Hilaire H, Christy MR, Wise MW, Rodriguez ED. Anterolateral thigh flap for trauma reconstruction. Ann Plast Surg 2010; 64 (2) 164-168
• 19 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109 (7) 2219-2226 , discussion 2227–2230
• 20 Kuo YR, Seng-Feng J, Kuo FM, Liu YT, Lai PW. Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: review of 140 cases. Ann Plast Surg 2002; 48 (2) 161-166
• 21 Nasajpour H, Steele MH. Anterolateral thigh free flap for “head-to-toe” reconstruction. Ann Plast Surg 2011; 66 (5) 530-533
• 22 Acar MA, Güleç A, Aydin BK, Erkoçak OF, Yilmaz G, Şenaran H. Reconstruction of foot and ankle defects with a free anterolateral thigh flap in pediatric patients. J Reconstr Microsurg 2015; 31 (3) 225-232
• 23 Vandersteen C, Dassonville O, Chamorey E , et al. Impact of patient comorbidities on head and neck microvascular reconstruction. A report on 423 cases. Eur Arch Otorhinolaryngol 2013; 270 (5) 1741-1746
• 24 Cleveland EC, Fischer JP, Nelson JA, Wink JD, Levin LS, Kovach III SJ. Free flap lower extremity reconstruction in the obese population: does weight matter?. J Reconstr Microsurg 2014; 30 (4) 263-270