The distally based, venous supercharged anterolateral thigh flap

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Distally-based anterolateral thigh flaps are valuable for proximal leg and knee reconstruction.
• Venous congestion is a frequent complication, potentially leading to flap failure.

Purpose of the Study:

• To evaluate the efficacy of great saphenous vein supercharge for venous augmentation in distally-based anterolateral thigh flaps.
• To compare outcomes, including flap size and venous congestion, between flaps with and without venous supercharge.

Main Methods:

• Retrospective analysis of 18 distally-based anterolateral thigh flaps (14 supercharged, 4 not).
• Comparison of flap size, incidence of venous congestion, and clinical course.
• Supercharge involved great saphenous vein anastomosis to the proximal flap vein for antegrade drainage.

Main Results:

• Supercharged flaps were significantly larger than non-supercharged flaps (22.6 cm vs. 17.5 cm mean length).
• All four non-supercharged flaps experienced venous congestion (3-7 days), with two resulting in partial flap loss.
• No early venous congestion or partial flap loss occurred in supercharged flaps; two cases developed late congestion due to anastomotic occlusion, one successfully treated, one resulting in flap loss.

Conclusions:

• Preventive venous supercharge is recommended for large, distally-based anterolateral thigh flaps to mitigate venous congestion and improve success rates.
• Great saphenous vein supercharge is an effective method to restore antegrade venous drainage and enhance flap viability.