Pedicled anterolateral thigh flap: a versatile flap for difficult regional soft tissue reconstruction

Area of Science:

• Plastic Surgery
• Surgical Oncology

Background:

• Reconstructing extensive defects in the lower trunk, perineum, and upper thigh after oncological surgery presents a significant reconstructive challenge, particularly when avoiding complex microsurgical techniques.
• The pedicled anterolateral thigh (ALT) flap is recognized for its advantages, including substantial skin and soft tissue availability, long pedicle length, and proven reliability.

Purpose of the Study:

• To evaluate the utility and outcomes of pedicled ALT flaps in reconstructing post-oncosurgical defects of the lower trunk, perineum, and upper thigh.
• To present institutional experience with this reconstructive technique for challenging soft tissue defects.

Main Methods:

• A retrospective review of 85 pedicled ALT flaps performed in 78 patients between January 2005 and August 2008.
• The study included patients with post-oncological excision defects of the lower trunk, groin, perineum, and upper thigh, primarily those with locally advanced inguinal disease requiring wide excision and nodal resection.

Main Results:

• Satisfactory wound coverage was achieved in all but one patient (98.8% success rate).
• Flap sizes ranged from 50 cm² to 760 cm², with pedicle lengths between 8 and 14 cm.
• No functional deficit of the knee extensor mechanism was observed in patients during routine activities.

Conclusions:

• The pedicled ALT flap is a reliable and effective method for reconstructing extensive soft tissue defects in the lower trunk, perineum, and thigh following oncological resections.
• This technique offers a wide arc of rotation and significant skin replacement potential, proving valuable in complex oncoplastic reconstructions without the need for microsurgery.