phy, as described for the anterolateral flap. The anterolateral thigh flap is ideally suited for reconstruction in the oral and maxillofacial region. The enhancement should be homogeneous and similar in de-gree to that of the background muscles. In a study that involves 65 cases that underwent free anterolateral thigh chimeric flap reconstruction of defects in the head and neck regions, Kun Wu et al. Composition: Flaps may be comprised of skin, fascia . Posterior Thigh Fasciocutaneous Flap Anatomy The posterior thigh fasciocutaneous flap Cut scope of flap ranged from 11.5 cm × 5.5 cm to 25.5 cm × 14.5 cm. The enhancement should be homogeneous and similar in de-gree to that of the background muscles. Background: Free anterolateral thigh flap (ALT) is considered as one of the most popular reconstructive options for soft tissue defects of multiple body regions. The anterolateral thigh flap for groin and lower abdominal defects: a better alternative to the rectus abdominis flap. Fasciae and muscles (Figures 1, 2) The fascia lata is the deep fascia of the thigh, and completely encircles the muscles of the thigh. Anterolateral Thigh Phalloplasty. Flap prelamination is a second choice that gives high stricture rates. [] The anterolateral thigh flap, first described in 1984 by Song et al, is a fasciocutaneous flap usually based on the musculocutaneous and septocutaneous perforators of the descending branch of the lateral . The skin vessels that supply the skin can ei-ther be musculocutaneous perforators or septo-cutaneous vessels. The anterolateral thigh (ALT) flap is becoming a popular option for reconstructing a variety of soft-tissue defects, especially in the head and neck. The blood-supply arteries of the anterolateral thigh flap and the chimeric muscle flap are both stemmed from the descending branch of the lateral circumflex femoral artery. The major perforators to the skin paddle are normally located within a 2 to 3 cm . The anterolateral thigh (ALT) flap is becoming a popular option for reconstructing a variety of soft-tissue defects, especially in the head and neck. the use of a free anterolateral thigh flap (FALTF) with a lateral femoral circumflex artery (LFCA) pedicle in the repair of large‑area soft tissue defects. reported a new classification concept to divide the anterolateral thigh chimeric perforator flap into 3 types: trunk type (I type, 16.9%), branch type (II type, 69.3%), and bifurcation . ANTEROLATERAL THIGH FLAP CHENG-HUNG LIN, M.D.,* JONATHAN ZELKEN, M.D., CHUNG-CHEN HSU, M.D., CHIH-HUNG LIN, M.D., and FU-CHAN WEI, M.D. 13. The flap is outlined on the axis of the anterior superior iliac spine and the lateral patella. The descending branch of the LFCA is the most common blood supply of the anterolateral thigh (ALT). The length of the vascular pedicle is usually >8cm while the diameter of the blood vessel is about 2mm, making the flap easier to operate. Perforators can be marked with a pencil Doppler to help design the outline of the flap. Twelve patients were repaired forearm skin defect used anterolateral thigh flap within 10 days called as the second phase. Plast Surg 2003;56:401e8. 12 Free anterolateral thigh flap can repair different types of lower extremity wounds, 13,14 including covering heel and dorsum skin . A flap based on septocutane- Anterolateral thigh (ALT) flap is now widely used because of its reliable blood supply to the skin paddle. Methods: A retrospective cohort study was conducted. This leaflet explains more about ALT flaps to fill defects on the leg, . The radial forearm free flap (RFFF), anterolateral thigh (ALT), fibula free flap (FFF), and the scapular free flap are among the more commonly used FF to reconstruct defects in head and neck. Posterior Thigh Fasciocutaneous Flap Anatomy The posterior thigh fasciocutaneous flap Anatomy Overview: Workhorse flap in plastic surgery given that it is a highly versatile. Anterolateral thigh (ALT) free flap and jejunal flap (JF) were commonly used in tissue reconstruction for pharyngoesophageal squamous cell carcinoma (PESCC) with worsening tissue adhesion and necrosis after radiotherapy failure. The anterolateral thigh flap is classically described as a fasciocutaneous perforator flap based on the septocutaneous perforator vessels, or more predomintantly, the musculocutaneous perforator vessels that arise from the descending branch of the lateral circumflex femoral artery (LCFA), the largest branch of the profunda femoris system in the . Less commonly, the blood supply may occasionally be based on the trans-verse branch of the LCFA, in cases where the descending branch is absent or small. Results: Dominant perforator supply to the anterolateral thigh was most commonly from the descending (57 to 100 percent), transverse (4 to 35 percent), oblique (14 to 43 percent), or ascending (2.6 to 14.5 percent) branch. The anterolateral thigh flap Perforator flaps from the anterolateral thigh receive their blood supply from perforating vessels that arise from the descending branch of the circumflex femoral artery. Thinning of the flap may extend its usefulness to situations requiring less bulk, and the successful use of this technique has previously been described in the Far East. The lateral circumflex femoral artery (LCFA), which gives off the as-cending, transverse, and descending branches, is the first branch of the deep femoral artery. The anterolateral thigh (ALT) flap was first described as a free cutaneous flap from the anterolateral aspect of the thigh, based on a septocutaneous perforator. [Google Scholar] Koshima I, Kawada S, Etoh H, et al. The blood supply of the flap and the blood ooze beneath the flap were intensively monitored, The anterolateral thigh flap has the advantages of thin and pliable skin, long and large pedicle, inconspicuous donor scar and the technical possibility of combination with fascia, sensory nerve . In 2-3% of patients, a blood clot can develop in one of the blood vessels attached to the flap. History by Song et al 1984 - 1st introduced 1986 - for head & neck reconstruction 1st described by Koshima et al 1992 - 1st microvascular transfer of VL muscle flap - Wolff 1995 - for lower extremity defect 1996 - ultrathin flap (3-4 mm) preserving subdermal plexus - Kimura et al Very popular reconstructive . Vascular delay increases perfusion, as delay causes blood vessel formation by limiting the blood supply available to a flap before transfer. We have successfully The reconstruction of large scalp and dural defects is difficult. Anterolateral thigh (ALT) flap is now widely used because of its reliable blood supply to the skin paddle. The anterolateral thigh (ALT) flap was described in 1984 by Song et al. Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator anterolateral thigh flap on the blood supply to the skin. Only one group of blood vessels needs to be anastomosed intraoperatively to reconstruct the blood circulation of multiple independent tissue flaps 10 . Effects of thinning the anterolateral thigh flap on the blood supply to the skin. We observed a decrease in the pedicle diameter of the anterolateral thigh flap, but the blood supply to the skin paddle was adequate. Accepted on April 6, 2017 as a fasciocutaneous flap based on perforators of the descending branch of the lateral femoral circumflex artery. The anterolateral thigh flap is a fasciocutaneous flap based on the septocutaneous or musculocutaneous perforators of the descending branch of the lateral circumflex femoral artery. Vascularized fascia can be included or the pedicle may be . The Gracilis Myocutaneous Free Flap: A Quantitative Analysis of the Fasciocutaneous Blood Supply and Implications for Autologous Breast Reconstruction Iain S. The key differences between a graft and a flap is in regards to its blood supply; a skin graft receives its blood supply from the recipient site though the vascular bed, whilst a skin flap brings its blood supply . Innervation by provided by the lateral femoral cutaneous nerve which is connected to one of the dorsal clitoral nerves. Conclusions: When tube-in-tube urethra reconstruction is not possible (94.2 percent of cases), a skin flap such as the superficial circumflex iliac artery perforator flap or the radial forearm flap is used for urethral reconstruction in anterolateral thigh phalloplasties. This can mean that the supply of blood to and from the flap can be stopped/ significantly reduced. Read "Blood Perfusion of the Free Anterolateral Thigh Perforator Flap: Its Beneficial Effect in the Reconstruction of Infected Wounds in the Lower Extremity, World Journal of Surgery" on DeepDyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Soft-tissue defects i … The distally-based anterolateral thigh flap is an attractive option for proximal leg and knee coverage but venous congestion is common. . Patients with thick thigh tissues who elect to have an ALT phalloplasty will likely require a two-stage urethral lengthening procedure. The anterolateral thigh (ALT) flap has widespread use throughout the body because of the many engineering options. It is based on an area of skin and fascia on the anterolateral aspect of the thigh supplied by perforators of the descending branch of the lateral circumflex femoral artery. It can be harvested as a fasciocutaneous or myocutaneous flap. Project Description. July 28, 2021. The descending branch of the LFCA is the most common blood supply of the anterolateral thigh (ALT). anterolateral thigh flap grafted 12 the shape of the flap and the blood supply of the hand were good Patient 4 38 male 12 10 Right side 1 Pale, low temperature III°-IV° high-tension electrical burn 14 Debridement, Ulnar artery reconstruction left flow-through anterolateral thigh flap grafted 6 the shape of the flap and the blood supply of the . This animated video, intended for surgical fellows in the field of Ear, Nose and Throat, or ENT, surgery, introduces viewers to the surgical procedure for an anterolateral thigh perforator flap subfascial harvest technique.Resecting tumours of the head and neck may require a skin graft to be harvested from another part of the patient to repair tissue loss. Skin grafts and skin flaps are two surgical techniques that are commonly utilised by plastic surgeons when a defect cannot be closed by primary or secondary intention.. 71-3 and 71-4 ). The rectus femoris is dominantly supplied by the vascular pedicle which takes off from the same source artery that is harvested with the anterolateral thigh flap. The thickness of the skin and sub-cutaneous fat are important factors in determining the . Anterolateral thigh flap appears to be a viable option for pharyngoesophageal reconstruction. Keywords: Anterolateral thigh flap, External fixation, Dermatoplasty. Br J Plast Surg. Br J Plast Surg. Though pedicled anterolateral thigh flap is useful to resurface soft tissue defects of multiple anatomical locations within its reach, its versatility is less reported. Posterior tibial vessels were used as the recipient vessel just below the level of the medial malleolus. Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Additionally, ALT can be harvested with a large skin paddle and large, well-vascularized fascia. Alkureishi LW, Shaw-Dunn J, Ross GL (2003) Effects of thinning the anterolateral thigh flap on the blood supply to the skin. Because the blood supply to the muscular portion of these thigh flaps is intact, the flaps enhance on CT and MRI. The anterolateral thigh flap lies on the axis of the septum dividing the vastus lateralis and the rectus femoris muscles. The descending branch supplies the anterolateral thigh and rectus femoris flaps. Information for patients . Skin availability is limited in Gracilis flaps and rectus abdominis myocutaneous flap leads to abdominal wall weakness. This can be because the blood vessel has twisted on itself, there is pressure on the blood vessel, or . . Alkureishi LW, Shaw-Dunn J, Ross GL. The flow-through flap offers the surgeon the ability to treat a vascular injury or high-grade stenosis to maintain distal perfusion, while also providing soft tissue coverage. The blood supply of this flap is supported by the descending branch of the lateral circumflex femoral artery, its applicability therefore re-quiring a complex reconstructive solution [12]. Plast Reconstr Surg 2014; 133:162. The lateral thigh flap was first described by Baek in 1983 as a fascial or fasciocutaneous flap based on the smaller vessels that extend from the profunda femoris system to the skin. A "distant" flap is anatomically remote from the recipient bed and may be free or pedicled. Additionally, ALT can be harvested with a large skin paddle and large, well-vascularized fascia. This type of flap has been frequently used in head and neck reconstruction ( 3, 4 ). The mean weight of the specimen removed was 350 g in the three patients who underwent immediate reconstruction, and the mean weight of the entire anterolateral . With the development of microsurgery, the application of free flaps in hand defects is gradually increasing, e.g., the paraumbilical perforator flap, latissimus dorsi flap, anterolateral thigh (ALT) flap, and tensor fasciae latae flap 2. The anterolateral thigh (ALT) flap (Fig. Dr Subhakanta Mohapatra IPGME&R,Kolkata.INDIA 2. The reader must be aware of the variability of the blood supply. Results: Average follow-ups time was 15 months. D'Arpa S (1), Claes K, Lumen N, Oieni S, Hoebeke P, Monstrey S. (1)Ghent, Belgium; and Palermo, Italy From the Departments of Plastic and Reconstructive Surgery and Urology, Ghent University Hospital; and the Department of Surgical, Oncological and Oral . As surgical techniques to dissect . ARTICLE HISTORY Received 17 February 2016 Anterolateral thigh flap 1. Wound of 10 patients were healed in first phase and healing time were 14-18 days. We report two cases of poliomyelitis in which an anterolateral thigh myocutaneous free flap was harvested from the paralytic limb for oral reconstruction. If there is a problem with the whole artery or vein, the entire flap can lose its blood supply. Anterolateral Thigh Flap with Dr. Brett Phillips. phy, as described for the anterolateral flap. In fact, the majority of ALT flaps are based on musculocutaneous perforators. Thinning of the flap may extend its usefulness. In a review by Wei et al9 of 672 anterolateral thigh flaps, the vessels that supply the anterolateral thigh skin was noted to be musculocutaneous in 87% of cases and septo-cutaneous in 13%. PubMed Abstract | CrossRef Full Text | Google Scholar It is well documented that the fascia lata receives sufficient blood supply via the prefascial and subfascial vascular plexus when attached to the anterolateral thigh flap.10 From the technical point of view, for these two cases, the lateral incision of the flap was made superficial to the fascia lata, and a posterior extension of the fascia . We have successfully treated eight scalp and dural composite defect cases (five male and three female) using ALT with . The anterolateral thigh (ALT) flap is a versatile soft tissue flap. Because the blood supply to the muscular portion of these thigh flaps is intact, the flaps enhance on CT and MRI. 22-4) is a very popular flap for lower limb reconstruction for several reasons. Anterolateral thigh flap is the ideal flap to repair forearm skin defect combined with muscles and bone exposure, which characteristics were anatomical fixing position, high survival rate and good recovery of forearm function and appearance. Thin anterolateral thigh 2. However, the results of tissue reconstruction and postoperative complications of these two flaps are controversial. After a resection, he underwent reconstruction with free anterolateral thigh (ALT) fascia flap and skin graft with blood supply accessed through a small facelift incision. Anterolateral thigh (ALT) flap . The lateral circumflex femoral artery along with its septocutaneous branches and musculocutaneous perforators are the main blood supply of anterolateral thigh flaps, a soft-tissue flap used in reconstructive surgeries. Plast Reconstr Surg 2003;112:1875e85. Flow-through anterior thigh flaps for one-stage reconstruction of soft-tissue defects and revascularization of ischemic extremities. Anterolateral Thigh Flap. 11. Modified free anterolateral thigh perforator flap, with little damage in donor site, a reliable blood supply by making a cross-bridge microvascular anastomosis with pretibial or posterior tibial blood vessel on normal leg, is a reliable alternative method for repairing soft tissue defects with the main vessels of serious injury in the middle . Thus, the instep donor defect was covered with a free anterolateral thigh flap, while the T‐portion of the descending branch of the lateral circumflex femoral vessel was interposed within the transected medial plantar vessel providing additional blood supply to the ischemic flap (Figures 23 and 24). Classically the descending branch originates out of the profunda femoris, together with the ascending and transverse branch, deep to the rectus femoris and sartorius muscles. Lateral superior genicular artery, which is a branch off the popliteal, if the blood supply for a reverse ALT; Massive posttraumatic defects of the foot in 4 patients and a tibial malunion in another were repaired by flow-through anterior (anterolateral and anteromedial) thigh flaps. The ALT has a complex local vasculature, which can be of importance for the surgical approach. an anterolateral thigh flap 1 month later. Anterolateral thigh flap and local skin flaps.2 Sartorius has a segmental blood supply (Type IV) and thin muscle belly, which is not suitable in many of the cases for the type of defect we need to cover. The anterolateral thigh flap is a septoutaneous artery flap based on the septocutaneous or muscle perforators of the lateral circumflex femoral system that is suitable for reconstruction of defects in an oral floor with tongue and esophageal deficits, scalp defects with dural defects, and for large full thickness defects of the lip. Modified free anterolateral thigh perforator flap, with little damage in donor site, a reliable blood supply by making a cross-bridge microvascular anastomosis with pretibial or posterior tibial blood vessel on normal leg, is a reliable alternative method for repairing soft tissue defects with the main vessels of serious injury in the middle . The initial model of flap design based on a random pattern blood supply has now evolved to flaps based on specific perforator based blood supply. Yang WG, Chiang YC, Wei FC, et al. Indi-cations for the anterolateral thigh flap in the other four patients were thin lower abdomens and plans for future pregnancy (Table I). An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction . Flap Cast. However, the glansplasty is performed at a later stage due to the difference in blood supply of the anterolateral thigh versus the radial forearm flap. Septocutaneous perforators were present in 19.8 percent (0 to 61.5 percent) of cases overall (n = 2486). This artery runs caudally in the intermuscular septum between the rectus femoris and vastus lateralis, giving off multiple septocutaneous and musculocutaneous . Blood supply of the anterolateral thigh depends upon perforators from the descending branch of the circumflex femoral pedicle. 2,3,19 It can be harvested as either a fasciocutaneous or a musculocutaneous flap, depending on the amount of soft tissue required. The anteromedial thigh flap (AMT) lies adjacent to the anterolateral thigh flap (ALT) area and can be used as a backup whenever the ALT is not feasible. The anterolateral thigh flap involves the skin paddle, the descending branch pedicle of the lateral circumflex femoral artery, and the perforators to the skin paddle. Arterial supply of the flap by either septocutaneous or musculocutaneous perforator is well documented. Urethral Reconstruction in Anterolateral Thigh Flap Phalloplasty: A 93-Case Experience. From May 2015 to October 2019, 17 patients with skin and soft tissue defects around the knee or in proximal . This type of flap has been frequently used in head and neck reconstruction (3,4). It can be used for large soft tissue defects both extraorally and intraorally (Figs. The Anterolateral Thigh (ALT) Flap is a skin, fat and fascia flap that has blood supplied by the descending branch of the lateral femoral circumflex vessels. et al. The Anterolateral Thigh (ALT) Flap is a skin, fat and fascia flap that has blood supplied by the descending branch of the lateral femoral circumflex vessels and innervation provided by the lateral femoral cutaneous nerve. If this occurs, it usually happens within the first two days and means that you will have to return to the operating theatre to have the clot removed. Pedicled anterolateral thigh (ALT) flap phalloplasty can be limited by inadequate perfusion. The more technical demand of the anterolateral thigh flap must be weighed against an easily harvested . Whitaker1,2., Maria Karavias1., Ramin Shayan1, Cara Michelle le Roux1, Warren M. Rozen1, Russell J. Corlett1, G. Ian Taylor1, Mark W. Ashton1* 1 The Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville . anterolateral thigh is essential before at-tempting to harvest an ALT flap. The anterolateral thigh flap is one of the commonest soft tissue flap performed today. Close Up View: This 67 year old patient with recurrent skin cancer of the nose, cheek and upper lip underwent combined management in the operating room to achieve full tumor . Br J Plast Surg 56(4):401-408. doi:S0007122603001255 [pii] Google Scholar Introduction. This represents a paradigm shift in how flaps may be designed and much more research is required to not only determine the overall vascular territories of perforator flaps but to also understand the . The descending branch pedicle is situated between the rectus femoris and vastus lateralis muscle. The anterolateral thigh flap is largely supplied by the musculocutaneous (87%) or septocutaneous (13%) perforators of the descending branch of the lateral circumflex femoral artery (LCFA). In general, the flap receives its perfusion from branches of the lateral circumflex femoral artery (LCFA). The descending branch can be harvested with the anterolateral thigh skin to enlarge the perfused vascular territory of the TFL flap. The TFL muscle flap is supplied by the ascending branch of the lateral circumflex femoral artery. The reconstruction of large scalp and dural defects is difficult. The sensation of the ALT flap, while good, tends to be . (2003) 56:401-8. doi: 10.1016/S0007-1226(03)00125-5. Literature published on the AMT flap is limited, and the vascular anatomy of the AMT flap is not well understood. Its thickness varies; laterally it becomes thicker as it forms the iliotibial tract, a structure that runs to the tibia and Br J flaps: 46 cases. The LCFA, however, has a large 2003; 56:401-408. The anterolateral thigh flap has the advantages of thin and pliable skin, long and large pedicle, inconspicuous donor scar and the technical possibility of combination with fascia, sensory nerve . [1] in 1984, the anterolateral thigh flap has been con-sidered to be an universal and preferential free flap [ 2, 3] for the reconstruction of limb wounds, owing to its con- . In this study, we present a case series of 3 patients who underwent flow-through anterolateral thigh free flap for lower extremity soft tissue coverage. Objective: To investigate the clinical effects of retrograde anterolateral thigh perforator flaps assisted with computed tomography angiography (CTA) in repairing skin and soft tissue defects around the knee or in proximal lower leg. The anterolateral thigh flap is widely used. Alkureishi L WT, Shaw-Dunn J, Ross G L. Effects of thinning the anterolateral thigh flap on the blood supply to the skin.
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