A pedicled anterolateral thigh ap containing the vastus lateralis muscle is a good option for reconstructing complex lower abdominalwall defects. This article presents our clinical experience with the use of the dalt flaps based on the oblique branch of the lateral circumflex femoral artery lcfa to reconstruct defects in the genicular and popliteal regions. The anterolateral thigh alt flap, based on the lateral circumflex femoral system, was first described by song in a paper in 1984. So far, this flap has not been described for resurfacing such defects. The anterolateral thigh alt flap has been used successfully as a pedicled flap, and has primarily been used in the reconstruction of the perineal, groin, and abdominal wall. The anterolateral flaps attributes that make it useful in pelvic reconstruction are its long and reliable vascular pedicle and the large amount of skin and soft tissue it can provide. The anterolateral thigh alt flap has become one of the workhorse flaps in reconstructive surgery for wounds all over the body, as a pedicled or free flap.
We present our experience of using pedicled alt flaps for repairing various defects. We performed a single center, retrospective study of patients who underwent phalloplasty with vaginectomy and fulllength urethroplasty using an anterolateral thigh pedicled. When the flap is used for perineal reconstruction, it is raised. This technique allows even the most complex of abdominal wall. This video demonstrates elevation of a groin flap and its coverage for hand defects. It was originally described in the 1980s, primarily by groups in asia, for head and neck reconstruction. The versatility of pedicled anterolateral thigh flap. The urethral defect was reconstructed with the vascularized fascia lata.
Case report reconstruction of abdominal wall defects using. Review reconstruction with pedicled anterolateral thigh flap. Reconstruction of extensive oncosurgical defects of lower trunk, perineum and upper thigh, without the complexity of microsurgery, is a reconstructive challenge. Pedicled flap reconstruction for patients with pressure. Recently, perforator flap surgery has been introduced in phalloplasty procedures. Reconstruction with pedicled anterolateral thigh flap after wide local excision of penoscrotal extramammary pagets disease. Pdf the versatility of pedicled anterolateral thigh flap. Phalloplasty with an innervated island pedicled anterolateral. When the size of the flap was less than 8 cm in the transverse axis, primary closure of the donor site was possible. Especially the anterolateral thigh alt flap has found its application as a pedicled flap for the penile reconstruction.
As a pedicled flap islanded on its vascular pedicle, it is used to reconstruct the inguinal region. Proximal pedicled anterolateral thigh flap for reconstruction of trochanteric defect. Pedicled anterolateral thigh flaps and their use in. Pedicled vastus lateralisanterolateral thigh flaps can provide skin, fascia, and muscle tissue. Perforators can be marked with a pencil doppler to help design the outline of the flap. Modification of the pedicled anterolateral thigh myocutaneous. Pdf pedicled anterolateral thigh flaps and their use in. The repair of complex penile defect with composite. The pedicled anterolateral thigh palt flap is an underutilized flap for locoregional reconstruction largely because methods to maximize its reach are neither universally implemented nor fully. Pedicled anterolateral thigh flap is highly versatile with a wide arc of rotation.
Technique to safeguard the superficial circumflex iliac artery and lateral cutaneous nerve of the thigh is. A tertiary referral center experience from india ravikiran naalla shashank chauhan sharmistha bhattacharyya maneesh singhal. Conclusion we used a pedicled vastus lateralis anterolateral thigh ap for muscle layer reconstruction. Pedicled anterolateral thigh flap is a versatile option for reconstruction of complex soft tissue defects in varied anatomical regions. Phalloplasty with an innervated island pedicled anterolateral thigh flap in a femaletomale transsexual kenjiro hasegawa, yuzaburo namba, and yoshihiro kimata department of plastic and reconstractive surgery, okayama university graduate school of medicine, dentistry and pharmaceutical sciences, okayama 7008558, japan. The pdf file you selected should load here if your web browser has a pdf reader plugin installed. In case a free flap is contraindicated, a pedicled flap, such as the anterolateral thigh flap, should be used. Its use as a pedicled flap has been described at length in the reconstructive literature for a variety of indications including trochanteric pressure ulcers, groin defects, perineal. Pdf pedicled anterolateral thigh fasciocutaneous flap with. Distally based anterolateral thigh flap pedicled on the.
Hence, contralateral myocutaneous anterolateral thigh alt flap 35. Pdf alternative vascular pedicle of the anterolateral. May 30, 2015 the anterolateral thigh alt flap has been used successfully as a pedicled flap, and has primarily been used in the reconstruction of the perineal, groin, and abdominal wall. In this article, the authors evaluate their experience with consecutive cases of the pedicled anterolateral thigh flap in complex abdominal and pelvic reconstruction.
Distally based anterolateral thigh flap pedicled on the oblique. The alt flap was designed following a welldescribed conventional pattern 5,6. While phalloplasty with an island pedicled or free anterolateral thigh flap has been reported previously, the present case seems to be the first of phalloplasty with an innervated island pedicled. Chimeric anterolateral thigh flap for total thoracic. Adequate shaping of the flap and the need of transferring the shaped flap on its pedicle to the pubic area requires precise localisation and preoperative evaluation of the perforators. The remaining part of the flap was used for the resurfacing of the right cavernous body and penile skin defects.
This is a prospective intraoperative analysis of the vascular anatomy of the lateral thigh that focuses on clinically important variations that impact flap harvest. Pedicled flap reconstructions, such as the posterior and anterolateral thigh flaps and, more recently, the vastus lateralis myocutaneous flap, have been used in advanced cases with extensive loss of soft tissue or exposed bony structures. Although more commonly used as a free flap, the anterolateral thigh flap can be harvested as a pedicled flap to cover tissue defects in the groin, lower abdomen, perineum, trochanter, and knee. The anterolateral thigh pedicled perforator flap for closure of a groin defect with lymphorrhea following vascular surgery in a peripheral vascular disease patientcase report. The anterolateral thigh alt pedicled flap is a reliable flap based on perforators of the lateral circumflex femoral system.
A distally based anterolateral thigh dalt flap is an alternative option for reconstructing defects around the knee. Pdf innervated island pedicled anterolateral thigh flap. Though pedicled anterolateral thigh flap is useful to resurface soft tissue defects of multiple anatomical locations within its reach, its versatility is less reported. In addition, they have a long neurovascular pedicle, reach up to the periumbilical area, and can be used to cover large defects. We performed a single center, retrospective study of patients who underwent phalloplasty with vaginectomy and fulllength urethroplasty using an anterolateral thigh pedicled flap or a radial forearm free flap from april 20 to july 2016. Three abdominal defects, three pedicled flaps wounds. Clinical use of a pedicled anterolateral thigh flap request pdf.
Pedicled anterolateral thigh flap for complex trochanteric p. The anterolateral thigh flap lies on the axis of the septum dividing the vastus lateralis and the rectus femoris muscles. Pedicled anterolateral thigh flaps for salvage reconstruction. Original article groin reconstruction by anterolateral thigh. Additionally, it has a long pedicle with a suitable vessel diameter, which is able to anastomose with the recipient vessels beyond the injured. Anterolateral thigh alt free flap for head and neck. A line is drawn from the anterior superior iliac spine to the lateral aspect of the patella. Blocksma et al 1 initially described muscle flap coverage for paraplegic patients in 1949. During the flap dissection a direct septocutaneous pedicle was. Today, penile reconstruction using phalloplasty is available. Contralateral pedicled anterolateral thigh flap atl for. We used a composite pedicled fasciocutaneous anterolateral thigh flap with an innervated vastus lateralis muscle to reconstruct the pelvic. Preoperative planning of a pedicled anterolateral thigh alt flap for penile reconstruction with the multidetector ct scan. Reconstruction of abdominal wall defects using a pedicled.
Flap harvest mark a line from the anterior superior iliac spine asis to the lateral corner of the upper border of the patella bone axis and mark its halfway point. Tensor fascia lata flap, rectus femoris muscle flap. Pdf the anterolateral thigh pedicled perforator flap for. Pedicled anterolateral thigh flap for complex trochanteric. Original article groin reconstruction by anterolateral. A pedicled anterolateral thigh alt flap for reconstruction. It has been used extensively to cover local defects in the groin and thigh regions. Utilizing the anterolateral thigh flap as a free tissue transfer for abdominal wall reconstruction is well described 2,10,1821. Review reconstruction with pedicled anterolateral thigh. Free anterolateral thigh flap alt is considered as one of the most popular reconstructive options for soft tissue defects of multiple body regions. The flap is outlined on the axis of the anterior superior iliac spine and the lateral patella. Background the anterolateral thigh flap is known for variations of its vascular pedicle.
Contralateral pedicled anterolateral thigh flap world journal of. The anterolateral flap s attributes that make it useful in pelvic reconstruction are its long and reliable vascular pedicle and the large amount of skin and soft tissue it can provide. The interpolated anterolateral thigh flap islanded on its vascular pedicle, is a durable local flap option for large skin and soft tissue defects caused by inguinal block dissections. Clinical use of a pedicled anterolateral thigh flap.
Pedicled vastus lateralis anterolateral thigh aps can provide skin, fascia, and muscle tissue. Innervated island pedicled anterolateral thigh flap for neophallic reconstruction in femaletomale transsexuals. Reconstructive surgery for severe penile inadequacy. Versatility of the proximally pedicled anterolateral thigh. The standard technique of flap harvesting was followed, which consisted of flap planning, harvesting and flap insetting. This flap is composed of the skin and subcutaneous. Though the pedicled anterolateral thigh alt flap has been used to cover a. Adequate shaping of the flap and the need of transferring the shaped flap on its pedicle to the pubic area requires precise localisation and preoperative evaluation of the. Pedicled vastus lateralis anterolateral thigh flaps can provide skin, fascia, and muscle. Application of the pedicled anterolateral thigh flap to. Figure 1 this flap would necessarily have a shorter pedicle. It offers bulk, sensate cover, and has an enormous skin replacement potential. Distally based anterolateral thigh flap pedicled on the oblique branch of the lateral circumflex femoral artery. Sinove, yves, e kyriopoulos, p ceulemans, philippe houtmeyers, piet hoebeke, and stan monstrey.
The pedicled anterolateral flap can be used to reconstruct the lower abdominal wall, perineum, penis, and scrotum. Pedicled anterolateral thigh flaps for salvage reconstruction of. Preoperative planning of a pedicled anterolateral thigh. Chung the free anterolateral thigh alt flap is a versatile flap. Preoperative planning of a pedicled anterolateral thigh alt. The complexity of the female pelvis and perineum becomes evident when traumatic or surgical defects need to be reconstructed. Pedicled vastus lateralisanterolateral thigh aps can provide skin, fascia, and muscle tissue. Versatility of the proximally pedicled anterolateral thigh f. Phalloplasty with an innervated island pedicled anterolateral thigh flap in a femaletomale transsexual kenjiro hasegawa, yuzaburo namba, and yoshihiro kimata department of plastic and reconstractive surgery, okayama university graduate school of medicine. Contralateral sandwich myocutaneous anterolateral thigh flap. The versatile anterolateral thigh flap journal of plastic. The anterolateral thigh alt flap has gained increased. Pedicled anterolateral thigh flap for contralateral groin composite. Pedicled anterolateral thigh alt flaps offer many advantages over other regional flaps for this purpose, such as the large skin area and soft.
Jan 21, 20 in its pedicled form, the alt flap is a versatile flap that may be employed to reconstruct the inferior posterior trunk, inferior abdomen, ipsilateral groin, ischium, anterior thigh, posterior thigh, and perineum. We present a case of a total thoracic esophageal reconstruction with an externally monitored chimeric anterolateral thigh flap, extending from the cervical esophagus to the retrosternal gastroplasty remnant. We used a pedicled vastus lateralis anterolateral thigh flap for muscle layer reconstruction. In its pedicled form, the alt flap is a versatile flap that may be employed to reconstruct the inferior posterior trunk, inferior abdomen, ipsilateral groin, ischium, anterior thigh, posterior thigh, and perineum. Free anterolateral thigh flap guang yang and kevin c. Narendra hulika, ramana reddy naru, azhagamuthu, basheeruddin inamdar, abha chandra dear editor the radical surgery for fungating inguinal lymph nodes is commonly done in patients with penile and vulvar cancers, creating complex groin defects. Also, the authors assessed the ability of the pedicled perforator flap to cover the above defects. Methods eightynine consecutive anterolateral thigh flaps were harvested. Three abdominal defects, three pedicled flaps wounds research. Expanding the applications of the pedicled anterolateral. Secondary salvage thoracic esophageal reconstruction surgery is usually performed with free or pedicled jejunum flaps or colon interposition. Contralateral sandwich myocutaneous anterolateral thigh. A pedicled anterolateral thigh flap for abdominal reconstruction after previous degloving injury of the donor site. Phallic reconstruction using the free radial forearm flap rff or the pedicled anterolateral thigh flap altf has been routinely used in femaletomale transsexuals.
Summarythe anterolateral thigh flap is based on the septocutaneous perforators of the lateral circumflex femoral artery. It has become a workhorse flap for reconstruction of various defects. The blood flow and the blood perfusion of pedicled anterolateral thigh alt flap was evaluated in 11 patients with skin and soft tissue defects by means of color doppler ultrasonography and of near. Contralateral pedicled anterolateral thigh flap atl for upper thigh defect in the era of free atl. Jan 19, 2015 pedicled anterolateral thigh alt flaps offer many advantages over other regional flaps for this purpose, such as the large skin area and soft. Anatomy of the pedicled anterolateral thigh flap for. Groin reconstruction by anterolateral thigh flap it can be combined with other local flaps e. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine. As a free microvascular transfer, it is used to resurface defects throughout the body. We used a pedicled vastus lateralisanterolateral thigh flap for muscle layer reconstruction.
A detailed intraoperative analysis was performed of the vasculature. It can provide abundant soft tissue coverage and minimal donor site morbidity. The anterolateral thigh flap can be used in a variety of ways to reconstruct defects in many areas. The pedicled anterolateral thigh flap is a useful addition to our armamentarium. Pdf on jan 1, 2017, ravikiran naalla and others published the versatility of pedicled anterolateral thigh flap. Pedicled anterolateral thigh alt flap offers many advantages over other regional flaps for this purpose, such as the large skin. A free flap, such as the radial forearm free flap, is the method of choice because of good aesthetic results, low donor site morbidity, and excellent erogenous sensitivity. Case report reconstruction of abdominal wall defects using a.
Pdf on dec 1, 2015, kong cheekwan and others published pedicled anterolateral thigh fasciocutaneous flap with fascia lata for. This case series aims to present the pedicled anterolateral thigh alt flap as a possible method of choice for reconstruction of fullthickness. A proximal pedicled flap can be used for lower abdomen, perineogenital, ischial, and trochanteric defects and the distal pedicled or a propeller flap for knee and proximal lower leg defects. Reconstruction of complex posttraumatic perinealpelvic. Versatility of anterolateral thigh perforator flap as a. Two cases are presented to highlight the technique. The pedicled anterolateral thigh island flap for inguinal. Aug 21, 2006 the blood flow and the blood perfusion of pedicled anterolateral thigh alt flap was evaluated in 11 patients with skin and soft tissue defects by means of color doppler ultrasonography and of near. However, due to restrictions in the pedicle length, it has only been used as cranially as the lower abdominal region. Metachronous carcinoma of rectum with reconstruction of a. By this submuscular transposition, an additional 5 cm length of the flap pedicle was gained. Material and methods the duration of the study was from january 2001 to.
Pdf the anterolateral thigh pedicled perforator flap for closure of a groin defect with lymphorrhea following vascular surgery in a peripheral vascular disease patientcase report carlos noronha academia. Pedicled vastus lateralisanterolateral thigh flaps can provide skin, fascia, and muscle. Despite the advantages of using a pedicled anterolateral thigh flap for abdominal wall reconstruction, there is currently a paucity of literature devoted to exploring this topic 2,4,7,17. Pedicled anterolateral thigh flap for vaginal and perineal. Versatility of the pedicled anterolateral thigh flap. When the flap is used for perineal reconstruction, it is raised with the patient in the lithotomy position. It provides excellent cover for defects in the lower abdomen, pelvis, and perineum. Handchirurgie mikrochirurgie plastische chirurgie 45 4.
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