Maxillofacial Plastic and Reconstructive Surgery

Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
권호 표지
DOI QR코드

DOI QR Code

Anatomical Review of Anterolateral Thigh Flap for the Oral and Maxillofacial Reconstruction

구강악안면재건을 위한 전외측대퇴피판의 해부학적 고찰

  • Kim, Soung Min (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Park, Jung Min (Department of Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Oh, Jin Sil (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Myoung, Hoon (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Lee, Jong Ho (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University)
  • 김성민 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 박정민 (서울대학교 치의학대학원 치학연구소) ;
  • 오진실 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 명훈 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 이종호 (서울대학교 치의학대학원 구강악안면외과학교실)
  • Received : 2012.10.19
  • Accepted : 2013.07.23
  • Published : 2013.07.31
Download PDF
⟨ Previous Next ⟩

Abstract

The anterolateral thigh flap (ALTF) is a versatile fasciocutaneous or myocutaneous flap, which can be harvested incorporating several skin islands and muscle components. The perforator of the ALTF is usually derived from the descending or transverse branch of the lateral circumflex femoral artery, and these vessels are based mainly on musculocutaneous perforators traversing the vastus lateralis muscle, and also based on the septocutaneous vessels running in between the rectus femoris and vastus lateralis muscle. Despite its usefulness for the oral cavity reconstruction, anatomic variations of these nutrient vessels, such as three main branches of ALTF and its relations with sartorius, vastus lateralis, tensor fasciae latae and rectus femoris muscle, have been reconstructive surgeons to be hesitated for the selection of ALTF. For the better understanding of ALTF as a routine reconstructive procedure in oral and maxillofacial surgery, various anatomical findings must be learned and memorized by young doctors in the course of the special curriculum periods for the Korean national board of oral and maxillofacial surgery. This review article will discuss the vascular anatomy and relavant anatomical variations of ALTF with Korean language.

Keywords

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;37:149-59. https://doi.org/10.1016/0007-1226(84)90002-X
  2. Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg 1989;42:260-2. https://doi.org/10.1016/0007-1226(89)90142-2
  3. 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;109:2219-26. https://doi.org/10.1097/00006534-200206000-00007
  4. Putz R, Pabst R. Sobotta atlas of human anatomy. 14th ed. Munich: Elsevier/Urban & Fischer; 2006.
  5. Standring S. Gray's anatomy: the anatomical basis of clinical practice. 39th ed. New York: Elsevier Churchill Livingstone;2005.
  6. Strauch B, Yu HL. Atlas of microvascular surgery: anatomy and operative approaches. 2nd ed. NewYork: Stuttgart; 2006. p.372-87.
  7. Coskunfirat OK, Ozkan O. Free tensor fascia lata perforator flap as a backup procedure for head and neck reconstruction. Ann Plast Surg 2006;57:159-63. https://doi.org/10.1097/01.sap.0000215869.96137.df
  8. Chalfoun CT, McConnell MP, Wirth GA, Brenner KA, Evans GR, Kobayashi M. Free tensor fasciae latae flap for abdominal wall reconstruction: overview and new innovation. J Reconstr Microsurg 2012;28:211-9. https://doi.org/10.1055/s-0032-1306368
  9. 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;18:866-71. https://doi.org/10.1097/scs.0b013e3180a03304
  10. Cömert A, Altun S, Unlü RE, Orbay H, Tekdemir I. Perforating arteries of the anteromedial aspect of the thigh: an anatomical study regarding anteromedial thigh flap. Surg Radiol Anat 2011;33:241-7. https://doi.org/10.1007/s00276-010-0738-x
  11. Camporro D, Fueyo A, Martín C, Carnero S, Llorente JL. Use of lateral circumflex femoral artery system free flaps in skull base reconstruction. J Craniofac Surg 2011;22:888-93. https://doi.org/10.1097/SCS.0b013e3182139cae
  12. Iyer S, Chatni S, Kuriakose MA. Free tensor fascia lata-iliac crest osteomusculocutaneous flap for reconstruction of combined maxillectomy and orbital floor defect. Ann Plast Surg 2012;68:52-7. https://doi.org/10.1097/SAP.0b013e31820ebc19
  13. Wong CH, Wei FC. Anterolateral thigh flap. Head Neck 2010;32:529-40.
  14. Wong CH, Wei FC, Fu B, Chen YA, Lin JY. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg 2009;123:571-7. https://doi.org/10.1097/PRS.0b013e318195658f
  15. Seth R, Manz RM, Dahan IJ, et al. Comprehensive analysis of the anterolateral thigh flap vascular anatomy. Arch Facial Plast Surg 2011;13:347-54. https://doi.org/10.1001/archfacial.2011.16
  16. 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;12:300-4. https://doi.org/10.1097/01.moo.0000130575.10656.97
  17. Erba P, Raffoul W, Bauquis O. Safe dissection of the distally based anterolateral thigh flap. J Reconstr Microsurg 2012;28:405-11.
  18. Neligan PC, Lannon DA. Versatility of the pedicled anterolateral thigh flap. Clin Plast Surg 2010;37:677-81. https://doi.org/10.1016/j.cps.2010.07.001
  19. Park JY, Park HD, Youn KH, et al. Anterolateral thigh flap for head and neck reconstruction: anatomic study. J Korean Assoc Maxillofac Plast Reconstr Surg 2005;27:360-4.
  20. Hanasono MM, Skoracki RJ, Silva AK, Yu P. Adipofascial perforator flaps for "aesthetic" head and neck reconstruction. Head Neck 2011;33:1513-9. https://doi.org/10.1002/hed.21637
  21. Agostini T, Agostini V. Adipofascial anterolateral thigh free flap for hemifacial atrophy. Acta Otorhinolaryngol Ital 2009;29:103-7.
  22. Lin PY, Chen CC, Kuo YR, Jeng SF. Simultaneous reconstruction of head and neck defects following tumor resection and trismus release with a single anterolateral thigh donor site utilizing a lateral approach to flap harvest. Microsurgery 2012;32:289-95. https://doi.org/10.1002/micr.21955
  23. Kekatpure VD, Trivedi NP, Shetkar G, Manjula BV, Mathan Mohan A, Kuriakose MA. Single perforator based anterolateral thigh flap for reconstruction of large composite defects of oral cavity. Oral Oncol 2011;47:517-21. https://doi.org/10.1016/j.oraloncology.2011.03.023
  24. 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;19:263-8. https://doi.org/10.1097/MOO.0b013e328347f845
  25. Posch NA, Mureau MA, Flood SJ, Hofer SO. The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects. Br J Plast Surg 2005;58:1095-103. https://doi.org/10.1016/j.bjps.2005.04.022
  26. 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;102:1517-23. https://doi.org/10.1097/00006534-199810000-00026
  27. Celik N, Wei FC, Lin CH, et al. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg 2002;109:2211-6. https://doi.org/10.1097/00006534-200206000-00005
  28. Camaioni A, Loreti A, Damiani V, Bellioni M, Passali FM, Viti C. Anterolateral thigh cutaneous flap vs. radial forearm free-flap in oral and oropharyngeal reconstruction: an analysis of 48 flaps. Acta Otorhinolaryngol Ital 2008;28:7-12.
  29. Kuo YR, Seng-Feng J, Kuo FM, Liu YT, Lai PW. Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: review of 140 cases. Ann Plast Surg 2002;48:161-6. https://doi.org/10.1097/00000637-200202000-00008
  30. Bianchi B, Ferri A, Ferrari S, et al. The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: one surgeon's experience in 92 cases. Microsurgery 2012;32:87-95. https://doi.org/10.1002/micr.20952
  31. Kesting MR, Hölzle F, Wales C, et al. Microsurgical reconstruction of the oral cavity with free flaps from the anterolateral thigh and the radial forearm: a comparison of perioperative data from 161 cases. Ann Surg Oncol 2011;18:1988-94. https://doi.org/10.1245/s10434-011-1584-8
  32. Spyriounis PK. The extended approach to the vascular pedicle of the anterolateral thigh perforator flap: anatomical and clinical study. Plast Reconstr Surg 2006;117:997-1001. https://doi.org/10.1097/01.prs.0000200616.63843.a7
  33. Liu WW, Yang AK, Ou YD. The harvesting and insetting of a chimeric anterolateral thigh flap to reconstruct through and through cheek defects. Int J Oral Maxillofac Surg 2011;40:1421-3. https://doi.org/10.1016/j.ijom.2011.05.020
  34. Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap: Systematic literature review of specific donor-site complications and their management. J Craniomaxillofac Surg 2013;41:15-21. https://doi.org/10.1016/j.jcms.2012.05.003
  35. Townley WA, Royston EC, Karmiris N, Crick A, Dunn RL. Critical assessment of the anterolateral thigh flap donor site. J Plast Reconstr Aesthet Surg 2011;64:1621-6. https://doi.org/10.1016/j.bjps.2011.07.015