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      The pedicled anterolateral thigh flap for trochanteric pressure sore reconstruction: Technical notes to optimize surgical outcomes

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          Abstract

          Background

          The pedicled anterolateral thigh (ALT) flap has become more popular for the reconstruction of soft-tissue defects in neighboring areas. Nonetheless, few studies in the literature have explored the use of this flap for trochanteric ulcer reconstruction. The aim of our study is to present the author’s experience of utilizing the ALT flap, with a focus on technical elements regarding the flap design and the tunneling method to maximize the reach of the flap.

          Methods

          The medical records of patients who received pedicled ALT flaps for the reconstruction of trochanteric pressure sores were retrospectively reviewed. The patients’ demographic data, operative details, and postoperative complications were evaluated.

          Results

          Between October 2018 and December 2019, 10 consecutive patients (age range, 13–45 years) underwent 11 pedicled ALT myocutaneous flaps for trochanteric pressure sore reconstruction. Each flap was designed around the most distal cutaneous perforator that was included in the proximal third of the skin paddle. The flaps ranged in size from 11×6 to 14×8 cm. The ALT flap was transposed through a lateral subcutaneous tunnel in five patients, while the open tunnel technique was used in six patients. All flaps survived, and no vascular compromise was observed.

          Conclusions

          The pedicled ALT flap is a safe and reliable option for reconstructing trochanteric pressure sores. An appropriate flap design and a good choice of the tunneling method are crucial for successful flap transposition.

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          Most cited references20

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          The tensor fascia lata musculocutaneous flap.

          Sean L. Hill, F Nahai, L Vasconez … (1978)
          The tensor fascia lata (TFL) muscle, together with the overlying skin of the anterolateral thigh, makes a reliable musculocutaneous unit. It can be lengthened safely by taking the fascia lata and the skin of the anterolateral mid and lower thigh to within 8 cm of the knee. The skin of the longer flap is supplied by large perforating musculocutaneous arteries, the terminal branches of the vascular pedicle of the muscle. The shorter flap can easily be transposed over the trochanteric area, while the larger flap will cover not only the trochanter but also the ischial and sacral areas. The flap serves equally well as a transposition, island, or free flap. The anatomical and vascular basis of the flap is presented, together with its application in 21 patients. Possible further applications of the flap, including anterior rotation, are discussed.
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            Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects.

            T Nakatsuka, Y Jitsuiki, W Ohyama … (1997)
            The anterolateral thigh flap has many advantages in head and neck reconstruction. However, it has not yet come into widespread use because of the anatomic variations of its perforators. Herein, we describe a safe operative technique related to the patterns of the perforators and discuss its wide versatility. A national cancer center hospital. Thirty-eight anterolateral thigh flaps were transferred. Confirmation and dissection of the flap pedicle were simultaneously performed with tumor resection. The design and elevation of the flap were carried out immediately after the tumor resection was completed. From the study of the anatomic variations of the perforators, septocutaneous patterns were recognized in 10 cases (26.3%) and musculocutaneous patterns in 28 cases (73.7%). All flaps were easily and safely elevated with our techniques. Thirty-six flaps survived. Partial necrosis was noted owing to excessive thinning procedure in one patient and total necrosis was noted owing to venous thrombosis at the anastomosis part in another patient. We found that the anterolateral thigh flap has numerous advantages. It is possible to perform the flap elevation and the tumor resection simultaneously. The flap is generally thin and is suitable for reconstruction of intraoral defects. Combined flaps with neighboring tissues and other, distant flaps can be used. Furthermore, since our technique minimizes the problems of confirmation and dissection of the perforators, we conclude that this flap can be successfully used to repair a variety of large defects of the head and neck.
            Article 0 comments Cited 17 times – based on 0 reviews     Review now
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              Efficacy of operative cure in pressure sore patients.

              N Goldberg, J Carlton, J J Disa (1992)
              The advent of air flotation-type beds and purified growth factors that may accelerate open wound contraction, coupled with very high recurrence rates and decreasing health resources, suggests that surgical reconstruction of pressure sores may not be indicated in all patients. In an effort to define which patients might benefit from operation, we reviewed the data from 40 consecutive patients with 68 pressure sores operated on under the direction of a single surgeon between 1981 and 1989. Patients were categorized on the basis of the presence or absence of paraplegia and its etiology. Sixty-six operations were performed, 55 muscle or fasciocutaneous flaps and 11 cutaneous flaps. There was a 36 percent operative complication rate, with no operative mortalities. Follow-up ranged from 1 to 71 months, with a mean of 21 months. Despite an 80% healed rate at the time of discharge, 61% of sores and 69% of patients had recurrent ulceration within a mean of 9.3 months. Analysis of these data indicates that surgical reconstruction of pressure sores does not appear to be efficacious in young posttraumatic paraplegics or cerebrally compromised elderly patients. Further review of the data failed to identify those patients likely to remain healed after operative repair of their pressure sores.
              Article 0 comments Cited 15 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Plast Surg
                Journal ID (iso-abbrev): Arch Plast Surg
                Journal ID (publisher-id): APS
                Title: Archives of Plastic Surgery
                Publisher: Korean Society of Plastic and Reconstructive Surgeons
                ISSN (Print): 2234-6163
                ISSN (Electronic): 2234-6171
                Publication date (Print): January 2021
                Publication date (Electronic): 15 January 2021
                Volume: 48
                Issue: 1
                Pages: 114-120
                Affiliations
                Department of Plastic Surgery, Qena University Hospital, Faculty of Medicine, South Valley University, Qena, Egypt
                Author notes
                Correspondence: Mahmoud A. Hifny Department of Plastic Surgery, Qena University Hospital, Faculty of Medicine, South Valley University, Qena 83523, Egypt Tel: +20-1019700881 Fax: +20-963211279 E-mail: mahmoud_abdallah0211@ 123456med.svu.edu.eg
                Author information
                http://orcid.org/0000-0001-8118-6166
                Article
                Publisher ID: aps-2020-01270
                DOI: 10.5999/aps.2020.01270
                PMC ID: 7861984
                PubMed ID: 33503754
                SO-VID: 358db486-3f75-4dc5-b4c8-5549d5ef743a
                Copyright © Copyright © 2021 The Korean Society of Plastic and Reconstructive Surgeons
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 June 2020
                Date revision received : 20 October 2020
                Date accepted : 27 October 2020
                Categories
                Subject: Extremity/Lymphedema
                Subject: Original Article

                ScienceOpen disciplines: Surgery
                Keywords: anterolateral thigh flap,trochanteric pressure sores,reconstruction
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: anterolateral thigh flap, trochanteric pressure sores, reconstruction

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