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Anterolateral Thigh (ALT) Free Flap Reconstruction in Western Populations
Joseph A. Knowles, MD; J. Scott Magnuson, MD; Eben L. Rosenthal MDUniversity of Alabama at Birmingham
INTRODUCTION RESULTS
Figure 1. ALT Free flap harvest starts with doppler identification of superficialperforators (arrows).
Figure 2. Muscle Layers of free flap are carefully harvested.
ABSTRACT
Introduction: In North America the anterolateral thigh (ALT) free flap has become increasingly utilized in head and neck reconstruction. It has minimal donor site morbidity and allows for a two-team approach. In the Western population, the ALT flap has not attained the popularity of East Asian countries. Our objective is to promote use of the ALT flap by investigating reasons why the
Methods: A case review was preformed on 913 patients under going free flap reconstruction at a tertiary care University medical center. Retrospective data was collected including operative course, race, sex, age, weight, health co-morbidities, smoking history and drug use.
Results: An ALT flap was explored in 80 of our free flap patients for reconstruction of defects caused by cancers of the head and neck. A total of 71 flaps (89%) were successfully raised without incident. Unilateral ALT exploration using perforators from the descending branches of the lateral circumflex femoral artery (LCFA) was less successful compared to bilateral exploration using both descending LCF and alternative flap perforators (89% v 96%, p=0.02). A total of 18 cases required an alternate flap, most commonly the radial forearm (67%) or the rectus (28%) free flaps. Long-term survival of all ALT flaps was 98.7%.
Conclusions: We found that anatomic variation of muscle perforators is the crucial factor affecting successful ALT flap use. In ALT flaps without identifiable descending branches of the LCF artery; successful flap harvests can be preformed by making use of superior muscle perforators and by exploration of the contra-lateral thigh. We recommend prepping bilateral ALT thigh sites prior to surgery and use of superficial perforators if no descending branches of the LCFA are available.
- ALT flap was attempted in 88 patients. Of these, 78 flaps (89%) were successfully harvested with exploration.
- In those cases requiring an alternate flap (n=10) a he radial forearm (60%) and rectus (40%) Survival of all ALT flaps was 98.7%.
- We performed a retrospective case review of 1,204 flap patients at a University Hospital. Data was collected on age, race, sex, co-morbidities and flap outcomes.
- Anatomic variation of muscle perforators justifies prepping of additional sites for flap reconstruction.
- The descending branch of the LCFA feeds into the perforators to the ALT flap.
- Variable patient anatomy can complicate locating perforators making dissections more difficult or requiring identification of an alternative harvest site.
METHODS AND MATERIALS CONCLUSIONS
Joseph A. Knowles M.D. University of Alabama at Birmingham
Email: [email protected] Phone: 205-996-5001
Website: Rosenthallab.com
CONTACT
Figure 3. ALT free flap with useful muscle bulk, intact vessels with nerve to vastus lateralis for nerve graft.
ALTOtherFlaps p-val
Age 65.5 61.2 0.02
Sex (F) 14.1% 23.6% 0.11
Race 11.3% 16.4% 0.34 African American
Table 1. Demographic comparison of ALT flap patients to all other flap patients
00%
10%
20%
30%
40%
50%
60%
70%ALT Patient Characteristics
