The anterolateral thigh flap has been used for coverage of defects in the foot and ankle for years. Conventional extended anterolateral thigh flaps do not undergo thinning procedures, which limit their application. Here, a clinical series of 24 patients is reported in which extended anterolateral thigh flaps were used for posttraumatic foot and ankle reconstruction. Of the 24 flaps, 14 were simple extended anterolateral thigh fasciocutaneous flaps and 10 were thinned extended anterolateral thigh flaps. One artery and two veins, including a superficial vein and an accompanying vein, were anastomosed to vascularize each flap. Follow-up of the 24 patients ranged from 10 months to 4 years postoperatively. All 24 flaps survived successfully, except one case that had partial flap necrosis distally due to excessive thinning. The cutaneous flap territory ranged from 250 cm2 to 400 cm2 (mean, 297 cm2). Only one patient received a debulking procedure. No ulceration occurred in any of the flaps due to contact with the shoe. The extended anterolateral thigh flap is a good alternative for extensive soft tissue defects of the foot and ankle. This study also supports the high reliability and excellent vascular supply of moderate thinned extended ALT flaps.
Benito-Ruiz J, Yoon T, Guisantes-Pintos E, Monner J, Serra-Renom JM (2004) Reconstruction of soft-tissue defects of the heel with local fasciocutaneous flaps. Ann Plast Surg 52: 380–384.
[3]
Chang SM, Zhang F, Yu GR, Hou CL, Gu YD (2004) Modified distally based peroneal artery perforator flap for reconstruction of foot and ankle. Microsurgery 24: 430–436.
[4]
Baumeister S, Radu CA (2009) Salvage reconstruction of the severely traumatized foot and ankle. Tech Orthop 24: 96–107.
[5]
Masquetlet AC, Romana MC, Wolf G (1992) Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 89: 1115–1121.
[6]
Fraccalvieri M, Bogetti P, Verna G, Carlucci S, Fava R, et al. (2008) Distally based fasciocutaneous sural flap for foot reconstruction: a retrospective review of 10 years experience. Foot Ankle Int 29(2): 191–198.
[7]
Baumeister SP, Spierer R, Erdmann D, Sweis R, Levin LS, et al. (2003) A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plast Reconstr Surg 112: 129–140.
[8]
Song YG, Chen GZ, Song YL (1984) The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 37: 149.
[9]
Saint-Cyr M, Schaverien M, Wong C, Nagarkar P, Arbique G, et al. (2009) The extended anterolateral thigh flap: Anatomical basis and clinical experience. Plast Reconstr Surg 123: 1245–1255.
[10]
Kuo YR, Seng-Feng J, Kuo FM, Liu YT, Lai PW (2002) Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: Review of 140 cases. Ann Plast Surg 48: 161–166.
[11]
Yildirim S, Avci G, Akoz T (2003) Soft-tissue reconstruction using a free anterolateral thigh flap: Experience with 28 patients. Ann Plast Surg 51: 37–44.
[12]
Mosahebi A, Disa JJ, Pusic AL, Cordeiro PG, Mehrara BJ (2008) The use of the extended anterolateral thigh flap for reconstruction of massive oncologic defects. Plast Reconstr Surg 122: 492–496.
[13]
Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, et al. (1993) Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 92: 421–430.
[14]
Rodriguez ED, Bluebond-Langner R, Copeland C, Grim TN, Singh NK, et al. (2009) Functional outcomes of posttraumatic lower limb salvage: A pilot study of anterolateral thigh perforator flaps versus muscle flaps. J Trauma 66: 1311–1314.
[15]
Zhang Q, Qiao Q, Gould LJ, Myers WT, Phillips LG (2010) Study of the neural and vascular anatomy of the anterolateral thigh flap. J Plast Reconstr Aesthet Surg 63: 365–371.
[16]
Wei FC, Jain V, Celik N, Chen HC, Chuang DC, et al. (2002) Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 109: 2219–2226.
[17]
Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K (1998) Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 102: 1517–1523.
[18]
Kawai K, Imanishi N, Nakajima H, Aiso S, Kakibuchi M, et al. (2004) Vascular anatomy of the anterolateral thigh flap. Plast Reconstr Surg 114: 1108–1117.
[19]
Baumeister S, Follmar KE, Zenn MR, Erdmann D, Levin LS (2008) Strategy for reoperative free flaps after failure of a first flap. Plast Reconstr Surg 122: 962–971.
[20]
Demirtas Y, Neimetzade T, Kelahmetoglu O, Guneren E (2010) Free anterolateral thigh flap for reconstruction of car tire injuries of children’s feet. Foot Ankle Int 31: 47–52.
[21]
Rubino C, Ramakrishnan V, Figus A, Bulla A, Coscia V, et al. (2009) Flap size/flow rate relationship in perforator flaps and its importance in DIEAP flap drainage. J Plast Reconstr Aesthet Surg. 62(12): 1666–70 doi:10.1016/j.bjps.2008.05.045.
Zhang Q, Qiao Q, Yang X, Wang H, Robb GL, et al. (2010) Clinical application of the anterolateral thigh flap for soft tissue reconstruction. J Reconstr Microsurg 26: 87–94.
[24]
Kimata Y, Uchiyama K, Ebihara S, Sakuraba M, Iida H, et al. (2000) Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 106: 584–589.
[25]
Santanelli F, Tenna S, Pace A, Scuderi N (2002) Free flap reconstruction of the sole of the foot with or without sensory nerve coaptation. Plast Reconstr Surg. 109(7): 2314–22 discussion 2323–4.
[26]
Ribuffo D, Cigna E, Gargano F, Spalvieri C, Scuderi N (2005) The innervated anterolateral thigh flap: anatomical study and clinical implications. . Plast Reconstr Surg. 115(2): 464–70.
