Has the anterolateral thigh flap replaced the latissimus dorsi flap as the workhorse for lower limb reconstructions?
OBJECTIVE
To compare the applicability and reliability of free Anterolateral thigh flap (ALTF) with Latissimus Dorsi free flap (LD) in different reconstructive scenarios of lower limb. To compare flap elevation time, vessel diameters, pedicle lengths, total operative time, peri-operative blood requirement, number of secondary procedures and complications between the two types of flaps.


METHODS
Patients of all age groups with lower limb soft tissue defects requiring free tissue transfer, reporting to Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from November 2005 to November 2008, were included in the study. The patients were distributed into two groups irrespective of the primary disease; Group 'A' patients underwent LD reconstruction and Group 'B' patients had an ALTF transfer.


RESULTS
A total of 60 cases were included in the study (Male : Female = 6.5 : 1). Mean patient age was 30.33 +/- 10.082 years. The mean follow up period was 19.73 +/- 9.303 months. Larger defects were covered with ALTF as compared to LD (p=0.003). The total surgery time was longer in Group 'A' (p=0.017). Peri-operative blood requirements and debulking procedures were also more frequently required in Group 'A' (p=0.002, 0.007). There was no significant difference in rest of the flap and operative parameters between the two groups.


CONCLUSIONS
ALTF is as reliable a flap as LD for various lower limb defects. Its additional advantages include short operation time, decreased requirement of peri-operative blood transfusion and subsequent debulking procedures. Considering these benefits, the ALTF may be labeled as the 'New Workhorse' for lower limb reconstructions requiring free tissue transfer.
Tamimy
Muhammad Sarmad
MS
Department of Plastic and Reconstructive Surgery, CMH Rawalpindi, Pakistan.
Rashid
Mamoon
M
Ehtesham-ul-Haq
Aman
Sameena
S
Aslam
Ayesha
A
Ahmed
Rao Saod
RS
D000293:Adolescent; D000328:Adult; D005260:Female; D005350:Fibroma / Q000601:surgery; D006801:Humans; D007869:Leg Injuries / Q000601:surgery; D035002:Lower Extremity / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery; D013524:Surgical Flaps; D055815:Young Adult