Distally Based Anterolateral Thigh Flap Algorithm for Unexpected Situations during Soft-Tissue Defect Reconstruction...

Area of Science:

• Microsurgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• The distally based anterolateral thigh (dALT) flap is a valuable technique for soft-tissue reconstruction around the knee.
• Intraoperative challenges can impede successful dALT flap harvest.
• A structured approach is needed to manage unexpected intraoperative findings.

Purpose of the Study:

• To propose and validate an algorithm for surgical conversion in cases of unexpected intraoperative findings during dALT flap harvest for knee reconstruction.
• To assess the rationality and outcomes of the proposed algorithm.

Main Methods:

• A retrospective analysis of 61 dALT flap harvests between 2010 and 2021 for knee soft-tissue defects.
• Development of a surgical conversion algorithm based on 21 cases (group B) with intraoperative anomalies.
• Comparison of outcomes (complication and flap loss rates) between planned harvests (group A, n=35) and converted cases (group B, n=21).

Main Results:

• Twenty-five patients required surgical conversion due to anomalies such as unsuitable perforators or compromised reverse flow.
• In group B, various flap conversions were performed, including anteromedial thigh flap, bipedicled dALT flap, rectus femoris muscle flap, and free ALT flap.
• No significant differences in complication or flap loss rates were observed between the planned (group A) and converted (group B) flaps.

Conclusions:

• The developed contingency planning algorithm for dALT flap surgery is rational and effective.
• Surgical conversions can often be performed through the same incision, maintaining acceptable patient outcomes.
• The algorithm provides a reliable strategy for managing intraoperative challenges in dALT flap reconstruction.