Distally-based free anterolateral thigh flap with a modified vena comitans

With the recent development in microsurgery, the use of a perforator flap has been widely implemented. If the length of the ALT flap pedicle is insufficient despite adequate preoperative planning, pedicle length extension is necessary. We planned for a reverse ALT free flap using the distal vessel of the descending branch for pedicle length extension in the case of ALT perforator branch originating from the proximal portion of the descending branch. For the management of venous congestion, the distal venae comitantes were anastomosed to the proximal venous stump in an antegrade manner, successfully resolving the venous congestion. Modified reverse-flow ALT free flap, wherein the venae comitantes are anastomosed to the proximal vein stump, is a good option that allows for relatively simple pedicle extension within the same operative field when securing an adequate pedicle length is difficult because of the origin of the perforator from the proximal descending branch, unlike the initial surgical plan.

Keywords

Lower extremity - Surgical flaps - Veins

Publication History

Received: 29 August 2018

Accepted: 26 October 2018

Article published online:
28 March 2022

• 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: 149-59
• 2 Luo LS, Gao JH, Chen LF. A new free skin flap–anterolateral femoral flap: it’s anatomy and clinical application. Chin J Plast Surg Burns 1985; 1: 50
• 3 Koshima I, Fukuda H, Yamamoto H. et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 1993; 92: 421-8
• 4 Wei FC, Celik N, Chen HC. et al. Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg 2002; 109: 45-52
• 5 Koshima I, Nanba Y, Tsutsui T. et al. Perforator flaps in lower extremity reconstruction. Handchir Mikrochir Plast Chir 2002; 34: 251-6
• 6 Koshima I, Nanba Y, Tsutsui T. et al. New anterolateral thigh perforator flap with a short pedicle for reconstruction of defects in the upper extremities. Ann Plast Surg 2003; 51: 30-6
• 7 Han HH, Jun D, Mun GH. et al. Modification of pedicle lengthening through perforator transposition in free anterolateral thigh flaps with pedicle size discrepancy: a case report. Microsurgery 2018; 38: 94-7
• 8 Han HH, Choi EJ, Oh DY. et al. The usefulness of microsurgical pedicle lengthening in free anterolateral thigh flaps. Microsurgery 2016; 36: 559-66
• 9 Gao SH, Feng SM, Chen C. et al. A new recipient artery for reconstruction of soft-tissue defects in the lower limb with a free anterolateral thigh flap: the reversed descending branch of the lateral femoral circumflex artery. Plast Reconstr Surg 2012; 130: 1059-65
• 10 Huang YH, Hsieh TY, Lai CS. et al. In situ pedicle lengthening of the anterolateral thigh flap. Plast Reconstr Surg 2014; 133: 85e-87e
• 11 Pan SC, Yu JC, Shieh SJ. et al. Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg 2004; 114: 1768-75
• 12 Zhou G, Zhang QX, Chen GY. The earlier clinic experience of the reverse-flow anterolateral thigh island flap. Br J Plast Surg 2005; 58: 160-4
• 13 Gravvanis AI, Tsoutsos DA, Karakitsos D. et al. Application of the pedicled anterolateral thigh flap to defects from the pelvis to the knee. Microsurgery 2006; 26: 432-8
• 14 Komorowska-Timek E, Gurtner G, Lee GK. Supercharged reverse pedicle anterolateral thigh flap in reconstruction of a massive defect: a case report. Microsurgery 2010; 30: 397-400
• 15 Kim IK, Kim TG, Lee JH. et al. The clinical course of reverse-flow anterolateral thigh flap: need to prepare for venous congestion and salvage operation. Arch Plast Surg 2012; 39: 262-4