scholarly journals The pedicled anterolateral thigh flap for trochanteric pressure sore reconstruction: Technical notes to optimize surgical outcomes

2021 ◽  
Vol 48 (1) ◽  
pp. 114-120
Author(s):  
Mahmoud A. Hifny
Keyword(s):  
Demographic Data ◽  
Pressure Sore ◽  
Good Choice ◽  
Anterolateral Thigh Flap ◽  
Pressure Sores ◽  
Skin Paddle ◽  
Tunneling Method ◽  
Anterolateral Thigh ◽  
Flap Design ◽  
Alt Flap

Background The pedicled anterolateral thigh (ALT) flap has become more popular for the reconstruction of soft-tissue defects in neighboring areas. Nonetheless, few studies in the literature have explored the use of this flap for trochanteric ulcer reconstruction. The aim of our study is to present the author’s experience of utilizing the ALT flap, with a focus on technical elements regarding the flap design and the tunneling method to maximize the reach of the flap.Methods The medical records of patients who received pedicled ALT flaps for the reconstruction of trochanteric pressure sores were retrospectively reviewed. The patients’ demographic data, operative details, and postoperative complications were evaluated.Results Between October 2018 and December 2019, 10 consecutive patients (age range, 13–45 years) underwent 11 pedicled ALT myocutaneous flaps for trochanteric pressure sore reconstruction. Each flap was designed around the most distal cutaneous perforator that was included in the proximal third of the skin paddle. The flaps ranged in size from 11×6 to 14×8 cm. The ALT flap was transposed through a lateral subcutaneous tunnel in five patients, while the open tunnel technique was used in six patients. All flaps survived, and no vascular compromise was observed.Conclusions The pedicled ALT flap is a safe and reliable option for reconstructing trochanteric pressure sores. An appropriate flap design and a good choice of the tunneling method are crucial for successful flap transposition.

scholarly journals Reconstructing ‘dual-defect’ pressure sores in spinal patients

2019 ◽  
Vol 2 (2) ◽  
pp. 21-27
Author(s):  
Ramin Shayan ◽  
Aoife Margaret Hurley ◽  
Derek Neoh ◽  
Dr Stephen Flood ◽  
Michael Weymouth
Keyword(s):  
Postoperative Complications ◽  
Spinal Injury ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Anatomical Landmarks ◽  
Greater Trochanter ◽  
Tertiary Referral Centre ◽  
Anterolateral Thigh ◽  
Preoperative Status ◽  
Alt Flap

Background: Recurrent pressure sores and unstable scars over the bony prominences of the greater trochanter and ischium are a troublesome sequela of spinal injury. A reliable reconstruction is needed for patients with ‘dual-defect’ pressure sores in these locations. We modified the pedicled anterolateral thigh (ALT) flap to fit the reconstructive requirements of ‘dual-defect’ pressure sores.Methods: Eleven consecutive patients with concurrent pressure sores (> grade III) or unstable scar in one of the ‘dual-defect’ areas and an active pressure sore in the other were identified from the Victorian state tertiary referral centre for spinal injuries. We describe the technique and clinical experience of pedicled ALT flaps for reconstruction of ‘dual-defect’ pressure sores in this patient cohort. Preoperative status and minor and major postoperative complications were recorded. Results: Eleven consecutive pedicled myocutaneous ALT flaps were performed for reconstruction of ‘dual-defect’ pressure sores. Several key variations in the anatomical landmarks and the intra-operative flap raise technique that are integral to the use of the ALT flap for this application are described herein. The average dimensions of the cutaneous pressure sore defects were 6 x 4.9 cm (greater trochanter) and 8.2 x 6.7 cm (ischial). The average dimensions of the cutaneous paddle of the flaps raised were 27.3 x 8.4 cm. Two postoperative complications necessitated return to theatre but no incidences of flap loss were recorded. Conclusions: The modified pedicled myocutaneous ALT provides a robust reconstructive solution for resurfacing ‘dual-defect’ pressure sores in spinal patients. Further recommendations for future technical adaptations are made.

scholarly journals Anterolateral Thigh Flap—the Optimal Flap in Coverage of Severe Elbow Injuries

2019 ◽  
Vol 52 (03) ◽  
pp. 314-321
Author(s):  
Venkata Koteswara Rao Rayidi ◽  
Panagatla Prakash ◽  
R Srikanth ◽  
Jammula Sreenivas ◽  
Karavattula Swathi
Keyword(s):  
Bone Fractures ◽  
Long Bone ◽  
Anterolateral Thigh Flap ◽  
Consecutive Series ◽  
Venous Anastomosis ◽  
Skin Paddle ◽  
First Choice ◽  
Anterolateral Thigh ◽  
Elbow Injuries ◽  
Alt Flap

Abstract Introduction Traditionally, the latissimus dorsi muscle with or without skin paddle has been the flap of choice for coverage of elbow defects. The ALT flap has found application in elective upper limb defects on account of it’s ability to be tailor made for individual defects. Our series of 10 cases shows the advantages of using this flap for acute trauma defects. Materials and Methods Consecutive 10 cases of severe elbow injuries, involving varying amounts of the lower arm and proximal forearm underwent debridement followed by coverage using the free anterolateral thigh flap. Nine of 10 arterial anastomosis were done end to side to the brachial artery and venous anastomosis to the veins accompanying the artery. Seven of these patients had long bone fractures and elbow dislocations, stabilised using external fixator. Four patients needed primary muscle or tendon repair and nerve repair or graft. Results There was 1 total flap loss, intraoperatively where a TFL flap had been used in a 71 year-old patient. Nine of 10 had successful wound coverage. Using Jupiter criteria, 2 had excellent, 3 had good, 3 had fair, and 1 had poor outcome. Conclusion This consecutive series of moderate and severe elbow injuries demonstrates that the ALT flap should be considered as the flap of first choice, specifically when there is a need.

Color Doppler Ultrasound versus Computed Tomography Angiography for Preoperative Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Reece Moore ◽  
Donna Mullner ◽  
Georgina Nichols ◽  
Isis Scomacao ◽  
Fernando Herrera
Keyword(s):  
Computed Tomography ◽  
Doppler Ultrasound ◽  
Computed Tomography Angiography ◽  
False Positive ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Preoperative Imaging ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background The anterolateral thigh (ALT) perforator flap is a commonly used flap with a predictable, though often variable, perforator anatomy. Preoperative imaging with color Doppler ultrasound (CDU) and computed tomography angiography (CTA) of ALT flap perforators can be a useful tool for flap planning. This study provides a complete review and analysis of the relevant preoperative ALT imaging literature. Methods Studies related to preoperative CDU and CTA imaging were reviewed, and information related to imaging method, sensitivity, false-positive rates, and perforator course identification (musculocutaneous vs. septocutaneous) were analyzed. Results A total of 23 studies related to preoperative ALT flap CDU and CTA imaging were included for review and analysis. Intraoperative perforator identification was compared with those found preoperatively using CDU (n = 672) and CTA (n = 531). Perforator identification sensitivity for CDU was 95.3% (95% CI: 90.9–97.6%) compared with the CTA sensitivity of 90.4% (95% confidence interval [CI]: 74.4–96.9%). The false-positive rate for CDU was 2.8% (95% CI: 1.1–4.5%) compared with 2.4% (95% CI: 0.7–4.1%) for CTA. Accuracy of perforator course identification was 95.5% (95% CI: 93.6–99.2%) for CDU and 96.9% (95% CI: 92.7–100.1%) for CTA. Conclusion CDU provides the reconstructive surgeon with greater preoperative perforator imaging sensitivity compared with CTA; however, false-positive rates are marginally higher with preoperative CDU. Preoperative imaging for ALT flap design is an effective tool, and the reconstructive surgeon should consider the data presented here when selecting a flap imaging modality.

scholarly journals Giant trochanteric pressure sore: Use of a pedicled chimeric perforator flap for cover

2009 ◽  
Vol 42 (01) ◽  
pp. 126-129
Author(s):  
Sandeep Mehrotra
Keyword(s):  
Perforator Flap ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Ageing Population ◽  
Fasciocutaneous Flaps ◽  
Anterolateral Thigh ◽  
Complex Wounds

ABSTRACTPressure sores are increasing in frequency commensurate with an ageing population with multi-system disorders and trauma. Numerous classic options are described for providing stable wound cover. With the burgeoning knowledge on perforator anatomy, recent approaches focus on the use of perforator-based flaps in bedsore surgery. A giant neglected trochanteric pressure sore in a paraplegic is presented. Since conventional options of reconstruction appeared remote, the massive ulcer was successfully managed by a chimeric perforator-based flap. The combined muscle and fasciocutaneous flaps were raised as separate paddles based on the anterolateral thigh perforator branches and provided stable cover without complications. Perforators allow versatility in managing complex wounds without compromising on established principles.

scholarly journals Pedicled anterolateral thigh flap for contralateral groin composite defect

2010 ◽  
Vol 43 (01) ◽  
pp. 103-105
Author(s):  
S. P. Bharath ◽  
G. Madhusudan ◽  
Suraj Manjunath
Keyword(s):  
Free Flaps ◽  
Anterior Superior Iliac Spine ◽  
Anterolateral Thigh Flap ◽  
Wide Resection ◽  
Vascular Pedicle ◽  
Anterolateral Thigh ◽  
Vascular Compromise ◽  
Femoral Vessels ◽  
Alt Flap ◽  
Composite Defect

ABSTRACTPedicled anterolateral thigh flap has been well described for ipsilateral groin defects. Its versatility depends on the intact femoral vessels. When the external iliac and the femoral vessels are absent, especially secondary to wide surgical tumour ablations in the groin region, ipsilateral ALT flap is not an option. Free flaps also are difficult because of lack of recipient vessels. We report a case of composite groin defect following wide resection of recurrent liposarcoma along with encased vessels which was covered with a pedicled anterolateral thigh flap from the opposite thigh. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine without vascular compromise, is described.

Anterolateral Thigh Flap Design by Using Suprafascial Course of the Perforator

2020 ◽  
Vol 84 (5) ◽  
pp. 550-553
Author(s):  
Zulfükar Ulas Bali ◽  
Yavuz Keçeci ◽  
Yüksel Pabuşcu ◽  
Levent Yoleri
Keyword(s):  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Flap Design

scholarly journals Aesthetic and Functional Outcomes of the Innervated and Thinned Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos Alberto Torres-Ortíz Zermeño ◽  
Javier López Mendoza
Keyword(s):  
Upper Extremity ◽  
Free Flaps ◽  
Sensory Function ◽  
Anterolateral Thigh Flap ◽  
Level Of Evidence ◽  
Average Percentage ◽  
Aesthetic Result ◽  
Anterolateral Thigh ◽  
Good Cosmetic ◽  
Alt Flap

Background. The anterolateral thigh (ALT) flap has been widely described in reconstruction of the upper extremity. However, some details require refinement to improve both functional and aesthetic results. Methods. After reconstruction of upper extremity defects using thinned and innervated ALT flaps, functional and aesthetic outcomes were evaluated with the QuickDASH scale and a Likert scale for aesthetic assessment of free flaps, respectively. Results. Seven patients with a mean follow-up of 11.57 months and average flap thickness of 5 mm underwent innervation by an end-to-end neurorrhaphy. The average percentage of disability (QuickDASH) was 21.88% with tenderness, pain, temperature, and two-point discrimination present in 100% of cases, and the aesthetic result gave an overall result of 15.40 (good) with the best scores in color and texture. Conclusions. Simultaneous thinning and innervation of the ALT flap lead to a good cosmetic result and functional outcome with a low percentage of disability, which could result in minor surgical procedures and better recovery of motor and sensory function. Level of Evidence. IV.

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