Distally-based free anterolateral thigh flap with a modified vena comitans

Area of Science:

• Microsurgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Perforator flaps, including the Anterolateral Thigh (ALT) flap, are integral to modern microsurgery.
• Insufficient pedicle length, even with preoperative planning, can complicate ALT flap reconstructions.
• The origin of the ALT perforator from the proximal descending branch can present challenges for pedicle length.

Purpose of the Study:

• To describe a modified reverse-flow ALT free flap technique for pedicle length extension.
• To address challenges posed by the proximal origin of the ALT perforator branch.
• To manage venous congestion in cases requiring extended pedicle length.

Main Methods:

• A reverse ALT free flap was planned using the distal vessel of the descending branch for pedicle extension.
• The distal venae comitantes were anastomosed to the proximal venous stump in an antegrade manner to manage venous congestion.
• This modified technique was applied when the perforator originated proximally, hindering standard pedicle length.

Main Results:

• The modified reverse-flow technique successfully extended the ALT flap pedicle length.
• Antegrade anastomosis of the distal venae comitantes to the proximal venous stump effectively resolved venous congestion.
• The procedure was feasible within the same operative field, simplifying reconstruction.

Conclusions:

• The modified reverse-flow ALT free flap is a valuable option for pedicle length extension in microsurgery.
• This technique is particularly useful when standard ALT flap pedicle length is compromised by proximal perforator origin.
• It offers a relatively simple and effective solution for managing venous congestion in challenging ALT flap reconstructions.