Download PDF
J Reconstr Microsurg 2014; 30(08): 509-514
DOI: 10.1055/s-0034-1378133
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Peripheral Vascular Disease on the Blood Supply of the Anterolateral Thigh Free Flap: A Radiographic Study

J. HyunBaek Ahn
1   Department of Oral and Maxillofacial Surgery, Northampton General Hospital, Northampton, United Kingdom
,
T. Mirza
1   Department of Oral and Maxillofacial Surgery, Northampton General Hospital, Northampton, United Kingdom
,
D. Thomas
2   Department of Radiology, Northampton General Hospital, Northampton, United Kingdom
,
P. Ameerally
1   Department of Oral and Maxillofacial Surgery, Northampton General Hospital, Northampton, United Kingdom
› Author Affiliations
Further Information

Publication History

16 February 2014

27 March 2014

Publication Date:
25 August 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Background The anterolateral thigh flap has gained popularity over the last few decades for the reconstruction of various surgical defects. The anatomy of the main perforating vessel of the anterolateral flap, the descending branch of the lateral circumflex femoral artery (dbLCFA), has been well described in the literature, however only one study has investigated its patency in patients with significant comorbidities. The aim of this study is to assess the degree of vascular stenosis of the dbLCFA in patients with multiple comorbidities.

Patients and Methods A total of 128 sets of angiographic data were collected from 93 patients retrospectively over a 12-month period. The percentage stenosis of superficial femoral artery (SFA), LCFA, and dbLCFA was measured and converted into an established scoring system.

Results The rate of dbLCFA stenosis was 12.5%. Interestingly, 24.0% of patients without peripheral vascular disease (PVD) showed some degree of stenotic changes in the dbLCFA, whereas only 10.7% of those with PVD had some degree of stenosis. There was no correlation between dbLCFA stenosis and patient comorbidity. The SFA was significantly affected by smoking, hypercholesterolemia (p < 0.05), and diabetes mellitus (p < 0.01)

Conclusions This study shows that the dbLCFA is not affected by patient comorbidity including PVD when compared with medically fit controls. Even in individuals with severe disease of the superficial vascular system; there is often sparing of the deep system. Surgical reconstruction using the anterolateral thigh flap is a safe procedure for patients even with multiple comorbidities including significant PVD and no additional preoperative investigations are required.

Keywords

anterolateral thigh flap - descending branch of lateral circumflex femoral artery - vascular stenosis - vascular disease - lower limb angiography
 

  • 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
    CrossrefPubMedGoogle Scholar
  • 2 Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg 1989; 42 (3) 260-262
    CrossrefPubMedGoogle Scholar
  • 3 Zhou G, Qiao Q, Chen GY, Ling YC, Swift R. Clinical experience and surgical anatomy of 32 free anterolateral thigh flap transplantations. Br J Plast Surg 1991; 44 (2) 91-96
    Google Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 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
    CrossrefPubMedGoogle Scholar
  • 6 Demirkan F, Chen HC, Wei FC , et al. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg 2000; 53 (1) 30-36
    CrossrefPubMedGoogle Scholar
  • 7 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
    Google Scholar
  • 8 Luo S, Raffoul W, Luo J , et al. Anterolateral thigh flap: A review of 168 cases. Microsurgery 1999; 19 (5) 232-238
    Google Scholar
  • 9 Shieh SJ, Chiu HY, Yu JC, Pan SC, Tsai ST, Shen CL. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 2000; 105 (7) 2349-2357 , discussion 2358–2360
    CrossrefPubMedGoogle Scholar
  • 10 Koshima I. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 2000; 105 (7) 2358-2360
    CrossrefPubMedGoogle Scholar
  • 11 Kuo YR, Yeh MC, Shih HS , et al. Versatility of the anterolateral thigh flap with vascularized fascia lata for reconstruction of complex soft-tissue defects: clinical experience and functional assessment of the donor site. Plast Reconstr Surg 2009; 124 (1) 171-180
    CrossrefPubMedGoogle Scholar
  • 12 Lin DT, Coppit GL, Burkey BB. Use of the anterolateral thigh flap for reconstruction of the head and neck. Curr Opin Otolaryngol Head Neck Surg 2004; 12 (4) 300-304
    CrossrefPubMedGoogle Scholar
  • 13 Park CW, Miles BA. The expanding role of the anterolateral thigh free flap in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (4) 263-268
    CrossrefPubMedGoogle Scholar
  • 14 Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg 1996; 97 (5) 985-992
    CrossrefPubMedGoogle Scholar
  • 15 Wong CH, Lin CH, Fu B, Fang JF. Reconstruction of complex abdominal wall defects with free flaps: indications and clinical outcome. Plast Reconstr Surg 2009; 124 (2) 500-509
    CrossrefPubMedGoogle Scholar
  • 16 Nosrati N, Chao AH, Chang DW, Yu P. Lower extremity reconstruction with the anterolateral thigh flap. J Reconstr Microsurg 2012; 28 (4) 227-234
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Kimata Y, Uchiyama K, Ebihara S , et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 2000; 106 (3) 584-589
    CrossrefPubMedGoogle Scholar
  • 18 Kuo YR, Jeng SF, Kuo MH , et al. Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site. Plast Reconstr Surg 2001; 107 (7) 1766-1771
    CrossrefPubMedGoogle Scholar
  • 19 Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 2010; 125 (1) 209-214
    CrossrefPubMedGoogle Scholar
  • 20 Wong CH, Wei FC. Anterolateral thigh flap. Head Neck 2010; 32 (4) 529-540
    PubMedGoogle Scholar
  • 21 Zhou H, Tan Q, Liu S , et al. Improved location technology of perforators of anterolateral thigh flap for Chinese patients. J Reconstr Microsurg 2013; 29 (5) 317-324
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Pan SC, Yu JC, Shieh SJ, Lee JW, Huang BM, Chiu HY. Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg 2004; 114 (7) 1768-1775
    CrossrefPubMedGoogle Scholar
  • 23 Choi SW, Park JY, Hur MS , et al. An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap. J Craniofac Surg 2007; 18 (4) 866-871
    CrossrefPubMedGoogle Scholar
  • 24 Tansatit T, Wanidchaphloi S, Sanguansit P. The anatomy of the lateral circumflex femoral artery in anterolateral thigh flap. J Med Assoc Thai 2008; 91 (9) 1404-1409
    PubMedGoogle Scholar
  • 25 Valdatta L, Tuinder S, Buoro M, Thione A, Faga A, Putz R. Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg 2002; 49 (2) 145-150
    CrossrefPubMedGoogle Scholar
  • 26 Kawai K, Imanishi N, Nakajima H, Aiso S, Kakibuchi M, Hosokawa K. Vascular anatomy of the anterolateral thigh flap. Plast Reconstr Surg 2004; 114 (5) 1108-1117
    PubMedGoogle Scholar
  • 27 Mäkitie AA, Beasley NJP, Neligan PC, Lipa J, Gullane PJ, Gilbert RW. Head and neck reconstruction with anterolateral thigh flap. Otolaryngol Head Neck Surg 2003; 129 (5) 547-555
    PubMedGoogle Scholar
  • 28 Pribaz JJ, Orgill DP, Epstein MD, Sampson CE, Hergrueter CA. Anterolateral thigh free flap. Ann Plast Surg 1995; 34 (6) 585-592
    CrossrefPubMedGoogle Scholar
  • 29 Hayden RE, Deschler DG. Lateral thigh free flap for head and neck reconstruction. Laryngoscope 1999; 109 (9) 1490-1494
    CrossrefPubMedGoogle Scholar
  • 30 Halvorson EG, Taylor HO, Orgill DP. Patency of the descending branch of the lateral circumflex femoral artery in patients with vascular disease. Plast Reconstr Surg 2008; 121 (1) 121-129
    PubMedGoogle Scholar
  • 31 Rozina SA, Bluebond-Langner R, Rodriguez ED, Cheng MH. The versatility of the anterolateral thigh flap. Plast Reconstr Surg 2009; 124: 395e-407e
    CrossrefPubMedGoogle Scholar
  • 32 Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg 2003; 30 (3) 473-480
    CrossrefPubMedGoogle Scholar
  • 33 Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg 2004; 114 (4) 910-916
    CrossrefPubMedGoogle Scholar
  • 34 Wallace CG, Kao HK, Jeng SF, Wei FC. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg 2009; 124 (6) e419-e426
    CrossrefPubMedGoogle Scholar
  • 35 Lutz BS. Aesthetic and functional advantages of the anterolateral thigh flap in reconstruction of tumor-related scalp defects. Microsurgery 2002; 22 (6) 258-264
    CrossrefPubMedGoogle Scholar
  • 36 Tsukino A, Kurachi K, Inamiya T, Tanigaki T. Preoperative color Doppler assessment in planning of anterolateral thigh flaps. Plast Reconstr Surg 2004; 113 (1) 241-246
    CrossrefPubMedGoogle Scholar
  • 37 Hage JJ, Woerdeman LA. Lower limb necrosis after use of the anterolateral thigh free flap: is preoperative angiography indicated?. Ann Plast Surg 2004; 52 (3) 315-318
    CrossrefPubMedGoogle Scholar