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[Soft tissue reconstruction in the extremities and the head and neck area using the anterolateral thigh free flap]
F Ensat1, H Schubert, M Hladik
1Abteilung für Plastische und Wiederherstellungschirurgie, Krankenhaus der Barmherzigen Brüder Salzburg, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität Salzburg, Kajetanerplatz 1, 5020, Salzburg, Österreich. florian.ensat@gmx.at
Objective:
Stable soft tissue coverage of exposed bone, tendons, or hardware in the extremities or the head and neck area with a microsurgically grafted free flap.
Indications:
Soft tissue defects measuring up to 42 × 15 cm in the extremities and the head and neck region.
Contraindications:
Previous surgery or trauma in the anterolateral thigh region. Insufficient personnel and/or technical resources.
Surgical Technique:
A line is marked from the anterior superior iliac spine to the superolateral patella pole, approaching the intermuscular septum between the rectus femoris and vastus lateralis muscle. The flap is centred on this line and after medial incision the perforators of the descending branch of the lateral circumflex femoral artery are identified and dissected to their origin. Afterwards the lateral incision is carried out and flap dissection is completed. After flap transfer microsurgical anastomoses are performed and the flap is sutured to the recipient region.
Postoperative Management:
Flap monitoring for 1 week. Strict elevation and immobilization after flap transfer to the extremities; bedrest for 1 week. Thrombosis prophylaxis.
Results:
From 2008-2011, 41 free anterolateral thigh flaps in 5 women and 36 men with an average age of 53 years (38-70 years) were performed for microsurgical soft tissue reconstruction. Total flap loss rate was 2.4 % and reoperation due to complications, e.g., hematoma, problems with microsurgical anastomosis, and partial flap loss was necessary in 13.8 % of patients.
