Vascular system anatomy of the anterolateral thigh flap
DOI: 10.32364/2587-6821-2021-5-8-517-524
A.V. Karpenko, R.R. Sibgatullin, A.A. Boyko, M.G. Kostova, O.M. Nikolaeva, I.A. Togo
Leningrad Regional Clinical Oncological Dispensary, St. Petersburg, Russian Federation
Aim: to analyze the anterolateral thigh flap use to eliminate oncological defects in the head and neck area with an emphasis on the flap raising characteristics.
Patients and Methods: 146 patients aged 33 to 80 y.o. underwent the surgery in the period from 2011 to 2020. Single-stage reconstruction (143 surgeries) of the various parts of the upper aerodigestive tract (142 surgeries) was mainly performed. Most of the patients (130 cases) underwent the surgery at the first stage of antitumor treatment. In 13 cases, surgical treatment was performed concerning tumor recurrences; in 3 — delayed secondary reconstruction was performed. Flap raising was conducted according to the generally accepted method without the use of preoperative mapping of perforators. The surgery protocols and medical histories were analyzed for the patterns of vascular anatomy and the number and nature of flap-related complications.
Results: typical vascular anatomy was noted in 115 cases (78.8%). When raising 31 flaps, anatomical deviations of the course and origin of cutaneous perforators were noted, which can be divided into 4 types: oblique branch anomaly (11 cases), upper type of anterolateral thigh flap (11), anteromedial thigh flap (6) and the rectus femoris muscle (3), while the latter type is rarely mentioned in the literature. The descending branch was the source of cutaneous perforator in 133 cases (91.1%). In 6 cases (3.9%), unfavourable vascular anatomy forced the use of a contralateral hip as a donor area. The reason for the failure in one of these cases was hypoplasia of the descending branch. The primary wound closure of the hip was performed in 143 patients (97.9%), even though the flap width exceeded 8 cm in 7 cases. Postoperative mortality was 1.4%. The main complications associated with the flap included: total flap loss (9 cases; 6.2%), partial necrosis (6; 4.1%) and donor wound complications (8; 5.5%).
Conclusion: the anterolateral thigh flap is an excellent plastic material, however, it requires knowledge of the vascular anatomy characteristics of adjacent hip zones.
Keywords: head and neck surgery, reconstructive surgery, reconstructive microsurgery, free revascularized flaps, anterolateral thigh flap.
For citation: Karpenko A.V., Sibgatullin R.R., Boyko A.A. et al. Vascular system anatomy of the anterolateral thigh flap. Russian Medical Inquiry. 2021;5(8):517–524 (in Russ.). DOI: 10.32364/2587-6821-2021-5-8-517-524.
About the authors:
Andrey V. Karpenko — C. Sc. (Med.), Head of the Department of Head and Neck Tumors, Leningrad Regional Clinical Oncological Dispensary; 37–39, Liteyny Prospekt,
St. Petersburg, 191014, Russian Federation; ORCID iD 0000-0002-4756-1310.
Ramil R. Sibgatullin — oncologist of the Department of Head and Neck Tumors, Leningrad Regional Clinical Oncological Dispensary; 37–39, Liteyny Prospekt,
St. Petersburg, 191014, Russian Federation; ORCID iD 0000-0003-3219-4420.
Alexander A. Boyko — oncologist of the Department of Head and Neck Tumors, Leningrad Regional Clinical Oncological Dispensary; 37–39, Liteyny Prospekt, St. Petersburg, 191014, Russian Federation; ORCID iD 0000-0003-1400-7775.
Mariana G. Kostova — oncologist of the Department of Head and Neck Tumors, Leningrad Regional Clinical Oncological Dispensary; 37–39, Liteyny Prospekt,
St. Petersburg, 191014, Russian Federation; ORCID iD 0000-0003-4597-184X.
Olga M. Nikolaeva — oncologist of the Department of Head and Neck Tumors, Leningrad Regional Clinical Oncological Dispensary; 37–39, Liteyny Prospekt, St. Petersburg, 191014, Russian Federation; ORCID iD 0000-0003-3658-4493.
Ivan A. Togo — oncologist of the Department of Head and Neck Tumors, Leningrad Regional Clinical Oncological Dispensary; 37–39, Liteyny Prospekt, St. Petersburg, 191014, Russian Federation; ORCID iD 0000-0002-5836-5825.
Contact information: Mariana G. Kostova, e-mail: kostova.90@mail.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 08.06.2021.
Revised 02.07.2021.
Accepted 27.07.2021.
2. Wolff K.-D. Perforator flaps: the next step in the reconstructive ladder? Br J Oral Maxillofac Surg. 2015;53(9):787–795. DOI: 10.1016/j.bjoms.2015.03.020.
3. Song Y.G., Chen G.Z., Song Y.L. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984;37(2):149–159. DOI: 10.1016/0007-1226(84)90002-x.
4. Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck. 2004;26(9):759–769. DOI: 10.1002/hed.20050.
5. Zhang C., Sun J., Zhu H. et al. Microsurgical free flap reconstructions of the head and neck region: Shanghai experience of 34 years and 4640 flaps. Int J Oral Maxillofac Surg. 2015;44(6):675–684. DOI: 10.1016/j.ijom.2015.02.017.
6. Xu Z., Zhao X.P., Yan T.L. et al. A 10-year retrospective study of free anterolateral thigh flap application in 872 head and neck tumour cases. Int J Oral Maxillofac Surg. 2015;44(9):1088–1094. DOI: 10.1016/j.ijom.2015.06.013.
7. Wolff K.-D., Kesting M., Thurmüller P. et al. The anterolateral thigh as a universal donor site for soft tissue reconstruction in maxillofacial surgery. J Craniomaxillofac Surg. 2006;34(6):323–331. DOI: 10.1016/j.jcms.2006.04.002.
8. Неведров А.В., Шибаев Е.Ю., Иванов П.А. и др. Аутотрансплантация антеролатерального бедренного лоскута — метод выбора в неотложной реконструктивной хирургии нижней конечности (анализ клинических наблюдений). Журнал им. Н.В. Склифосовского. Неотложная медицинская помощь. 2015;(3):69–73.[Nevedrov A.V., Shibaev E.Yu., Ivanov P.A. et al. Free anterolateral femoral flap is the first choice in emergency reconstructive surgery of the lower limb (analysis of clinical cases). Russian Sklifosovsky Journal. Emergency Medical Care. 2015;(3):69–73 (in Russ.)].
9. Chen H., Tang Y. Anterolateral thigh flap: an ideal soft tissue flap. Clin Plast Surg. 2003;30(3):383–401. DOI: 10.1016/s0094-1298(03)00040-3.
10. Wong C.-H., Wei F.-C. Anterolateral thigh flap. Head Neck. 2010;32(4):529–540. DOI: 10.1002/hed.21204.
11. Lu J.C.-Y., Zelken J., Hsu C.-C. et al. Algorithmic approach to anterolateral thigh flaps lacking suitable perforators in lower extremity reconstruction. Plast Reconstr Surg. 2015;135(5):1476–1485. DOI: 10.1097/PRS.0000000000001168.
12. Wei F., Jain V., Celik N. et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109(7):2219–2226; discussion 2227–2230. DOI: 10.1097/00006534-200206000-00007.
13. Hsieh C.-H., Yang J.C.-S., Chen C.-C. et al. Alternative reconstructive choices for anterolateral thigh flap dissection in cases in which no sizable skin perforator is available. Head Neck. 2009;31(5):571–575. DOI: 10.1002/hed.20995.
14. 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. DOI: 10.1097/00006534-199810000-00026.
15. Lin S.J., Rabie A., Yu P. Designing the anterolateral thigh flap without preoperative Doppler or imaging. J Reconstr Microsurg. 2010;26(1):67–72. DOI: 10.1055/s-0029-1234023.
16. Shimizu T., Fisher D.R., Carmichael S.W., Bite U. An anatomic comparison of septocutaneous free flaps from the thigh region. Ann Plast Surg. 1997;38(6):604–610. DOI: 10.1097/00000637-199706000-00007.
17. Yu P., Selber J. Perforator patterns of the anteromedial thigh flap. Plast Reconstr Surg. 2011 Sep;128(3):151e–157e. DOI: 10.1097/PRS.0b013e318221dd11.
18. Koshima I., Urushibara K., Inagawa K., Moriguchi T. Free tensor fasciae latae perforator flap for the reconstruction of defects in the extremities. Plast Reconstr Surg. 2001;107(7):1759–1765. DOI: 10.1097/00006534-200106000-00018.
19. Hong J.P., Kim E.K., Kim H. et al. Alternative Regional Flaps When Anterolateral Thigh Flap Perforator is not Feasible. J Hand Microsurg. 2010;2(2):51–57. DOI: 10.1007/s12593-010-0014-7.
20. Wong C.-H., Wei F.-C., 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. DOI: 10.1097/PRS.0b013e318195658f.
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