Safe dissection of the distally based anterolateral thigh flap.
BACKGROUND
The distally based anterolateral thigh (ALT) flap is an interesting reconstructive solution for complex soft tissue defects of the knee. In spite of a low donor site morbidity and wide covering surface as well as arch of rotation, it has never gained popularity among reconstructive surgeons. Venous congestion and difficult flap dissection in the presence of a variable anatomy of the vascular pedicle are the possible reasons.


METHODS
An anatomical study of 15 cadaver legs was performed to further clarify the blood supply of the distally based ALT. Our early experience with the use of preoperative angiography and a safe flap design modification that avoids distal intramuscular skeletonization of the vascular pedicle and includes a subcutaneous strip ranging from the distal end of the flap to the pivot point is presented.


RESULTS
The distally based ALT presents a constant and reliable retrograde vascular contribution from the superior genicular artery. Preoperative angiography reliably identified and avoided critical Shieh Type II pedicled flaps. The preservation of a subcutaneous strip ranging from the distal flap end to the upper knee was associated with the absence of venous congestion in a short case series.


CONCLUSIONS
Preoperative angiography and a flap design modification are proposed to allow the safe transfer of the distally based ALT to reconstruct soft tissue defects of the knee.
Plastic and Reconstructive Surgery, University Hospital Lausanne, Lausanne, Switzerland. paolo.erba@chuv.ch
Paolo
P
Erba
Wassim
W
Raffoul
Olivier
O
Bauquis
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001859:Bone Neoplasms / Q000601:surgery; D002102:Cadaver; D004210:Dissection / Q000379:methods*; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D011300:Preoperative Care; D003668:Pressure Ulcer / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply*; D013848:Thigh