[Anterolateral thigh flap for limb reconstructive surgery: four case reports]

We report four cases of anterolateral thigh flap reconstructions, searching for the different advantages and disadvantages of this type of flap.

A pure skin flap was used to cover tissue loss on the plantar surface of the foot both in weight-bearing and non-weight-bearing zones as well as to cover the dorsal aspect of the first commissura of the hand. A musculocutaneous flap (fragment of the vastus lateralis) was associated with an iliac cancellous graft to treat septic nonunion of the tibia. A composite tendinocutaneous flap (fragment of the iliotibial band) was used to reconstruct extensor tendon and skin loss on the dorsal aspect of the hand. A perforating artery measuring more than 1 mm was used in all cases, but in one flap it was in the position described by Song. Side-to-side anastomosis was used in one case. For three cases, the sutured circumflex artery had the same caliber as the radial artery at the wrist level. In one case the circumflex artery had a diameter greater than the posterior tibial artery. Closure of the donor site was not possible immediately in one case. A thin skin graft was required in three cases.

Skin healing after microsurgery was satisfactory in all cases, occurring within the usual delay. Bone healing in the patient with septic nonunion of the tibia was achieved at four months. The flap was reliable. In three cases the skin graft of the donor site only healed partially.

The advantages of the antero lateral thigh flap are: surgery in the supine position, spinal anesthesia when the recipient site is on the lower limb, flap reliability, use of the flap as a bridging element, use as a composite flap. The disadvantages are: variable position of usable perforants, requirement for wide skin grafts > 6 cm to cover the donor site.

The antero lateral thigh flap is a reliable flap that can be most useful when a bridging element is required and when the donor site can be closed directly.