Clinical applications of distally based anterolateral thigh flaps based on perforating vessels from lateral circumflex femoral artery oblique branch_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANG Liya ,  LIU Yuanbo , ZANG Mengqing , ZHU Shan , CHEN Bo , LI Shanshan

No.11 Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical School, Beijing, 100144, P.R.China;

Corresponding author：

LIU Yuanbo, Email: ybpumc@sina.com

Keywords：

Distally based anterolateral thigh flap; lateral circumflex femoral artery; oblique branch; descending branch; lower extremity; soft tissue defect; wound repair

DOI：

10.7507/1002-1892.201612091

Video：

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Objective To explore the feasibility and technical points of soft tissue defect reconstruction of the lower extremity using the distally based anterolateral thigh (dALT) flap based on perforating vessels from the lateral circumflex femoral artery (LCFA) oblique branch. Methods Between July 2010 and July 2016, 7 patients underwent defect reconstruction of the lower extremities using the dALT flap based on perforating vessels from the LCFA oblique branch. There were 4 males and 3 females with an average age of 26.7 years (range, 3-58 years). The etiologies included angiofibrolipoma in 1 case, malignant fibrous sarcoma in 1 case, soft tissue sarcoma in 1 case, and post-burn scar contracture in 4 cases. The disease duration was 13 years, 1 year, and 8 months in 3 patients with tumors respectively, and was from 6 months to 35 years in 4 patients with post-burn scar contracture. After resection of lesion tissues, the defect size ranged from 8 cm×6 cm to 24 cm×8 cm. The flap size ranged from 9 cm×7 cm to 24 cm×8 cm. The length of the pedicle ranged from 12 to 22 cm (mean, 16.6 cm). The distance from the flap pivot point to the superolateral border of the patella ranged from 9.5 to 14.0 cm (mean, 11.8 cm). The donor sites were directly closed in 6 cases and covered with the split-thickness skin graft in 1 case. Results All flaps survived after surgery without any major complications. All wounds at the donor and the recipient sites healed primarily. The patients were followed up from 5 to 54 months (mean, 30.7 months). The color, texture, and thickness of the flaps were similar to those of the surrounding skin. No tumor recurrence was observed. The range of motion of flexion and extension of the knee joint were greatly improved in the patients with post-burn scar contracture. Conclusion For patients who have the oblique branch from the LCFA descending branch which sends out perforating vessels to the skin of the anterolateral thigh region, a dALT flap could be used to reconstruct soft tissue defects of the lower extremities.

Citation： JIANG Liya, LIU Yuanbo, ZANG Mengqing, ZHU Shan, CHEN Bo, LI Shanshan. Clinical applications of distally based anterolateral thigh flaps based on perforating vessels from lateral circumflex femoral artery oblique branch. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(5): 559-563. doi: 10.7507/1002-1892.201612091 Copy

1.	张功林, 葛宝丰, 姜世平, 等. 逆行股前外侧岛状皮瓣和肌皮瓣移植术. 中华医学杂志, 1990, 70(12): 676-678.
2.	Wong CH, Wei FC, Fu B,et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2): 571-577.
3.	Xu DC, Zhong SZ, Kong JM,et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg, 1988, 82(2): 305-310.
4.	Kimata Y, Uchiyama K, Ebihara S,et al. Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg, 1998, 102(5): 1517-1523.
5.	Shieh SJ, Chiu HY, Yu JC,et al. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2349-2360.
6.	Hubmer MG, Feigl G. Alternative vascular pedicle of the anterolateral thigh flap: does an oblique branch really exist? Plast Reconstr Surg, 2010, 125(5): 1560-1581.
7.	Wong CH, Kao HK, Fu B,et al. A cautionary point in the harvest of the anterolateral thigh myocutaneous flap. Ann Plast Surg, 2009, 62(6): 637-639.
8.	Wong CH, Ong YS, Wei FC. The anterolateral thigh-Vastus lateralis conjoint flap for complex defects of the lower limb. J Plast Reconstr Aesthet Surg, 2012, 65(2): 235-239.
9.	Liu WW, Guo ZM. Reconstruction of wide-apart double defect using a branch-based chimeric anterolateral thigh flap. Plast Reconstr Surg Glob Open, 2014, 2(1): e96.
10.	Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
11.	da Costa AC, Lancelotti CL. Oblique branch of the lateral circumflex femoral artery also found in 32 percent of cadavers in Brazil. Plast Reconstr Surg, 2009, 124(3): 1011-1012.
12.	Wong CH. The oblique branch trap in the harvest of the anterolateral thigh myocutaneous flap. Microsurgery, 2012, 32(8): 631-634.
13.	Hallock GG. The vascular pedicle of the anterolateral thigh flap as an alternative recipient site for thigh free flaps. J Reconstr Microsurg, 2008, 24(2): 131-136.
14.	Gao SH, Feng SM, Chen C,et al. A new recipient artery for reconstruction of soft-tissue defects in the lower limb with a free anterolateral thigh flap: the reversed descending branch of the lateral femoral circumflex artery. Plast Reconstr Surg, 2012, 130(5): 1059-1065.
15.	Cadenelli P, Bordoni D, Radaelli S,et al. Proximally based anterolateral-thigh (ALT) flap for knee reconstruction: an advancement propeller perforator flap. Aesthetic Plast Surg, 2015, 39(5): 752-756.
16.	Ding Q, Zang M, Yu S,et al. Nearly total unilateral buttock reconstruction with a proximally pedicled anterolateral thigh flap: a case report. J Plast Reconstr Aesthet Surg, 2013, 66(6): e166-168.
17.	Zhou G, Zhang QX, Chen GY. The earlier clinic experience of the reverse-flow anterolateral thigh island flap. Br J Plast Surg, 2005, 58(2): 160-164.
18.	Demirseren ME, Efendioglu K, Demiralp CO,et al. Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal leg. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1613-1620.
19.	Pan SC, Yu JC, Shieh SJ,et al. Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg, 2004, 114(7): 1768-1775.
20.	Yu P. Inverse relationship of the anterolateral and anteromedial thigh flap perforator anatomy. J Reconstr Microsurg, 2014, 30(7): 463-468.
21.	Rozen WM, Grinsell D, Koshima I,et al. Dominance between angiosome and perforator territories: a new anatomical model for design of perforator flaps. J Reconstr Microsurg, 2010, 26(8): 539-545.

1. 张功林, 葛宝丰, 姜世平, 等. 逆行股前外侧岛状皮瓣和肌皮瓣移植术. 中华医学杂志, 1990, 70(12): 676-678.
2. Wong CH, Wei FC, Fu B,et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2): 571-577.
3. Xu DC, Zhong SZ, Kong JM,et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg, 1988, 82(2): 305-310.
4. Kimata Y, Uchiyama K, Ebihara S,et al. Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg, 1998, 102(5): 1517-1523.
5. Shieh SJ, Chiu HY, Yu JC,et al. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2349-2360.
6. Hubmer MG, Feigl G. Alternative vascular pedicle of the anterolateral thigh flap: does an oblique branch really exist? Plast Reconstr Surg, 2010, 125(5): 1560-1581.
7. Wong CH, Kao HK, Fu B,et al. A cautionary point in the harvest of the anterolateral thigh myocutaneous flap. Ann Plast Surg, 2009, 62(6): 637-639.
8. Wong CH, Ong YS, Wei FC. The anterolateral thigh-Vastus lateralis conjoint flap for complex defects of the lower limb. J Plast Reconstr Aesthet Surg, 2012, 65(2): 235-239.
9. Liu WW, Guo ZM. Reconstruction of wide-apart double defect using a branch-based chimeric anterolateral thigh flap. Plast Reconstr Surg Glob Open, 2014, 2(1): e96.
10. Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
11. da Costa AC, Lancelotti CL. Oblique branch of the lateral circumflex femoral artery also found in 32 percent of cadavers in Brazil. Plast Reconstr Surg, 2009, 124(3): 1011-1012.
12. Wong CH. The oblique branch trap in the harvest of the anterolateral thigh myocutaneous flap. Microsurgery, 2012, 32(8): 631-634.
13. Hallock GG. The vascular pedicle of the anterolateral thigh flap as an alternative recipient site for thigh free flaps. J Reconstr Microsurg, 2008, 24(2): 131-136.
14. Gao SH, Feng SM, Chen C,et al. A new recipient artery for reconstruction of soft-tissue defects in the lower limb with a free anterolateral thigh flap: the reversed descending branch of the lateral femoral circumflex artery. Plast Reconstr Surg, 2012, 130(5): 1059-1065.
15. Cadenelli P, Bordoni D, Radaelli S,et al. Proximally based anterolateral-thigh (ALT) flap for knee reconstruction: an advancement propeller perforator flap. Aesthetic Plast Surg, 2015, 39(5): 752-756.
16. Ding Q, Zang M, Yu S,et al. Nearly total unilateral buttock reconstruction with a proximally pedicled anterolateral thigh flap: a case report. J Plast Reconstr Aesthet Surg, 2013, 66(6): e166-168.
17. Zhou G, Zhang QX, Chen GY. The earlier clinic experience of the reverse-flow anterolateral thigh island flap. Br J Plast Surg, 2005, 58(2): 160-164.
18. Demirseren ME, Efendioglu K, Demiralp CO,et al. Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal leg. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1613-1620.
19. Pan SC, Yu JC, Shieh SJ,et al. Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg, 2004, 114(7): 1768-1775.
20. Yu P. Inverse relationship of the anterolateral and anteromedial thigh flap perforator anatomy. J Reconstr Microsurg, 2014, 30(7): 463-468.
21. Rozen WM, Grinsell D, Koshima I,et al. Dominance between angiosome and perforator territories: a new anatomical model for design of perforator flaps. J Reconstr Microsurg, 2010, 26(8): 539-545.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical applications of distally based anterolateral thigh flaps based on perforating vessels from lateral circumflex femoral artery oblique branch

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