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

 

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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.

Publication History

Received: 27 June 2020

Accepted: 27 October 2020

Article published online:
20 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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• REFERENCES

• 1 Disa JJ, Carlton JM, Goldberg NH. Efficacy of operative cure in pressure sore patients. Plast Reconstr Surg 1992; 89: 272-8
  CrossrefPubMedGoogle Scholar
• 2 Nahai F, Silverton JS, Hill HL. et al. The tensor fascia lata musculocutaneous flap. Ann Plast Surg 1978; 1: 372-9
  CrossrefPubMedGoogle Scholar
• 3 Neligan PC, Lannon DA. Versatility of the pedicled anterolateral thigh flap. Clin Plast Surg 2010; 37: 677-81
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 8 Chang SH. Anterolateral thigh island pedicled flap in trochanteric pressure sore reconstruction. J Plast Reconstr Aesthet Surg 2007; 60: 1074-05
  CrossrefPubMedGoogle Scholar
• 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: 671-06
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 11 Saint-Cyr M, Uflacker A. Pedicled anterolateral thigh flap for complex trochanteric pressure sore reconstruction. Plast Reconstr Surg 2012; 129: 397e-399e
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 13 Paletta CE, Freedman B, Shehadi SI. The VY tensor fasciae latae musculocutaneous flap. Plast Reconstr Surg 1989; 83: 852-8
  CrossrefPubMedGoogle Scholar
• 14 Siddiqui A, Wiedrich T, Lewis Jr VL. Tensor fascia lata V-Y retroposition myocutaneous flap: clinical experience. Ann Plast Surg 1993; 31: 313-7
  CrossrefPubMedGoogle Scholar
• 15 Lynch SM. The bilobed tensor fascia lata myocutaneous flap. Plast Reconstr Surg 1981; 67: 796-8
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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. 01.05.2020 [Epub]. https://doi.org/10.1007/s00238-020-01684-2
  CrossrefGoogle Scholar