Anterolateral Thigh Island Flap

PURPOSE: To present the author's experience using the anterolateral thigh island flap for reconstruction of soft tissue defects around the hip and perineum. MATERIALS AND METHODS: Proximal based anterolateral thigh island flaps were performed to reconstruct the soft tissue defects at the perineum (3 patients) and the greater trochanter of the hip (one patient) in 4 patients. All patients were male. Mean age was 43 years (range, 32 to 50 years) and mean follow-up was 8 months (range, 6 to 13 months). The causes of the defects were traffic accident in 2 cases, necrotizing fasciitis 1 case, and pressure sore 1 case. Average size of the flap was 14x9 cm. Fasciocutaneous flaps were performed in 3 patients and musculocutaneous flap was performed in one patient. RESULTS: All flaps were survived. There were no necrosis of the flaps. One flap presented venous congestion after surgery, which resolved with the decompression of the pedicle. Reconstruction with the anterolateral thigh island flap resulted in no recurrence of the infection or ulcer and good esthetic contour. CONCLUSION: The anterolateral thigh island flap is a reliable flap for reconstruction around the perineum and hip joint.

Reconstruction of Disarticulated Knee Stump by Using Distally Based Anterolateral Thigh Island Flap

PURPOSE: The basic vascular anatomy and versatility of the anterolateral thigh flap was reported firstly by Song in 1984 and then by Zhang who introduced the reverse flow pattern of this flap. In this case, the authors reviewed various articles and their experiences with the distally based anterolateral thigh flap and applied it for coverage of bone-exposed wound occurred at the distal of the disarticulated knee stump. We consequently reported the reliability and resourcefulness of this flap in the difficult and limited situation. METHODS: A 67-year-old-man who had suffered from arteriosclerotic obliterans inevitably underwent the disarticulation at knee joint due to clinical deterioration. He presented to our clinic with soft tissue necrosis and bone exposure at the stump. We debrided the wound and conducted the distally based anterolateral thigh island flap by transecting proximal portion of descending branch of the lateral circumflex femoral artery and the 14x10cm sized flap was transferred to cover the defect. The pedicle measured 14cm in length with pivot point 7cm above the patella. RESULTS: The postoperative course was mainly uneventful except early venous congestion for 4 days and subsequent partial skin loss. The wound was healed by secondary intension and no other sequelae had been observed during follow-up period of 12 months. CONCLUSION: Despite the presence of various reconstructive choices, the distally based anterolateral thigh island flap can be designed to repair soft tissue defects around the knee region, providing its reliable blood supply and long pedicle length, especially in the challenging cases.