DOI QR코드

DOI QR Code

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

  • Hifny, Mahmoud A. (Department of Plastic Surgery, Qena University Hospital, Faculty of Medicine, South Valley University)
  • Received : 2020.06.27
  • Accepted : 2020.10.27
  • Published : 2021.01.15

Abstract

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.

Keywords

References

  1. Disa JJ, Carlton JM, Goldberg NH. Efficacy of operative cure in pressure sore patients. Plast Reconstr Surg 1992;89: 272-8. https://doi.org/10.1097/00006534-199202000-00012
  2. Nahai F, Silverton JS, Hill HL, et al. The tensor fascia lata musculocutaneous flap. Ann Plast Surg 1978;1:372-9. https://doi.org/10.1097/00000637-197807000-00003
  3. 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
  4. Ng RW, Chan JY, Mok V, et al. Clinical use of a pedicled anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2008;61: 158-64. https://doi.org/10.1016/j.bjps.2007.10.028
  5. Zelken JA, AlDeek NF, Hsu CC, et al. Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps. Microsurgery 2016;36:104-14. https://doi.org/10.1002/micr.22354
  6. Friji MT, Suri MP, Shankhdhar VK, et al. Pedicled anterolateral thigh flap: a versatile flap for difficult regional soft tissue reconstruction. Ann Plast Surg 2010;64:458-61. https://doi.org/10.1097/SAP.0b013e3181b4bc70
  7. Hsu H, Chien SH, Wang CH, et al. Expanding the applications of the pedicled anterolateral thigh and vastus lateralis myocutaneous flaps. Ann Plast Surg 2012;69:643-9. https://doi.org/10.1097/SAP.0b013e3182749d31
  8. Chang SH. Anterolateral thigh island pedicled flap in trochanteric pressure sore reconstruction. J Plast Reconstr Aesthet Surg 2007;60:1074-5. https://doi.org/10.1016/j.bjps.2005.09.050
  9. Wang CH, Chen SY, Fu JP, et al. Reconstruction of trochanteric pressure sores with pedicled anterolateral thigh myocutaneous flaps. J Plast Reconstr Aesthet Surg 2011;64:671-6. https://doi.org/10.1016/j.bjps.2010.08.042
  10. Tzeng YS, Yu CC, Chou TD, et al. Proximal pedicled anterolateral thigh flap for reconstruction of trochanteric defect. Ann Plast Surg 2008;61:79-82. https://doi.org/10.1097/SAP.0b013e318151fb5b
  11. Saint-Cyr M, Uflacker A. Pedicled anterolateral thigh flap for complex trochanteric pressure sore reconstruction. Plast Reconstr Surg 2012;129:397e-399e. https://doi.org/10.1097/PRS.0b013e31823af1fb
  12. Saint-Cyr M, Oni G, Lee M, et al. Simple approach to harvest of the anterolateral thigh flap. Plast Reconstr Surg 2012; 129:207-11. https://doi.org/10.1097/PRS.0b013e318233ef4a
  13. Paletta CE, Freedman B, Shehadi SI. The VY tensor fasciae latae musculocutaneous flap. Plast Reconstr Surg 1989;83: 852-8. https://doi.org/10.1097/00006534-198905000-00012
  14. Siddiqui A, Wiedrich T, Lewis VL Jr. Tensor fascia lata V-Y retroposition myocutaneous flap: clinical experience. Ann Plast Surg 1993;31:313-7. https://doi.org/10.1097/00000637-199310000-00005
  15. Lynch SM. The bilobed tensor fascia lata myocutaneous flap. Plast Reconstr Surg 1981;67:796-8. https://doi.org/10.1097/00006534-198106000-00015
  16. Demirseren ME, Gokrem S, Ozdemir OM, et al. Hatchet-shaped tensor fascia lata musculocutaneous flap for the coverage of trochanteric pressure sores: a new modification. Ann Plast Surg 2003;51:419-22. https://doi.org/10.1097/01.SAP.0000054244.11278.EA
  17. Vijayasekaran A, Gibreel W, Carlsen BT, et al. Maximizing the utility of the pedicled anterolateral thigh flap for locoregional reconstruction: technical pearls and pitfalls. Clin Plast Surg 2017;44:371-84. https://doi.org/10.1016/j.cps.2016.12.004
  18. Kimata Y, Uchiyama K, Ebihara S, et al. Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Arch Otolaryngol Head Neck Surg 1997;123:1325-31. https://doi.org/10.1001/archotol.1997.01900120075012
  19. Kua EH, Wong CH, Ng SW, et al. The island pedicled anterolateral thigh (pALT) flap via the lateral subcutaneous tunnel for recurrent ischial ulcers. J Plast Reconstr Aesthet Surg 2011;64:e21-3. https://doi.org/10.1016/j.bjps.2010.07.021
  20. Hifny MA. Rotation advancement VY posterior thigh flap combined with a biceps femoris muscle flap for reconstruction of a recurrent ischial pressure sore in pediatric patients. Eur J Plast Surg 2020 May 7 [Epub]. https://doi.org/10.1007/s00238-020-01684-2.