title: Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction.
abstract: BackgroundThe anterolateral thigh (ALT) flap remains a workhorse for soft tissue reconstruction. However, the traditional ALT flap is often too bulky for resurfacing shallow, distal extremity defects, prohibiting adequate function, or well-fitted orthotics. This study evaluates extremity reconstruction using ALT flaps elevated in the suprafascial or super-thin plane.MethodsRetrospective review of ALT free flap reconstruction from October 2014 to July 2016 was performed. Suprafascial and super-thin flaps were those elevated just above the crural fascia and within the superficial scarpal plane, respectively. Adjunct operative procedures, demographics, and complications were recorded.ResultsA total of 25 patients underwent suprafascial (n= 14) or super-thin (n= 11) ALT flap reconstruction for primarily lower extremity wounds (n= 19), with an average age and body mass index of 53.8 years and 26.3 kg/m2, respectively. Follow-up was 6.3 months. Comorbidities included smoking (n= 7), diabetes (n= 8), peripheral vascular disease (n= 6), and hypertension (n= 8). The presence of hardware (n= 9), trauma (n= 10), and chronic infection (n= 12) were common risk factors. Average flap size was 8.2 × 21.5 cm, with 64% (n= 16) taken on one perforator. Forty-eight percent (n= 12) were end-to-side anastomoses and 62% (n= 13) utilized one venous anastomosis. Mean hospital stay was 7.8 days with a 24% (n= 6) complication rate. There were no partial or complete flap losses.ConclusionThe ALT flap, elevated in a suprafascial or super-thin plane, is a safe, effective option for extremity soft tissue reconstruction. The decreased flap volume and bulk provides the improved contour and pliability necessary for appropriate distal extremity function. The potential versatility of super-thin flaps reinforces the importance of continued innovation by reconstructive microsurgeons.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Akhil K
authors.initials: AK
authors.lastname: Seth
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.|Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Iorio
mesh_terms: D000368:Aged; D004954:Esthetics; D005121:Extremities / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D061525:Perforator Flap / Q000098:blood supply / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery; D013848:Thigh / Q000098:blood supply / Q000601:surgery*; D016896:Treatment Outcome