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“Vascular preparation first”: a valuable strategy in anterolateral thigh flap harvest

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Abstract

The anterolateral thigh flap is one of the most popular flaps in reconstructive surgery today. Versatility and minimal donor site morbidity are the distinct advantages of using this flap. However, possible anatomic variations in perforators or source vessels may present a challenge to the novice surgeons and those who are not familiar with the flap anatomy. These challenges may compromise flap reliability and undermine surgeon’s confidence. Therefore, to allow surgeons, especially in their first ALTs, to harvest a reliable ALT no matter how challenging the anatomy is, the authors propose a stepwise strategy that is reproducible and safe. As a result, the proposed approach of identifying available skin vessels first, addressing source vessels second, and revealing the origin and the course of skin vessels and source vessels third will simplify ALT flap harvest and allow flexibility in design.

Level of Evidence: Level IV, therapeutic study.

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Conflict of interest

None.

Author information

Correspondence to Chung-Kan Tsao.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video, Online Resource 1, which shows land marks, lines, and mapped skin vessels (MPG 61502 kb)

Video, Online Resource 2, which shows skin vessels identification (MPG 383520 kb)

Video, Online Resource 3, which shows identifying source vessels by opening the intermuscular septum between the rectus femoris and the vastus lateralis muscles (MPG 234916 kb)

Video, Online Resource 4, which demonstrates how perforators are unroofed and dissected and the pedicle is prepared proximally and distally (MPG 364966 kb)

Video, Online Resource 5, which shows the posterior margin of skin flap being cut and the muscle component being dissected (MPG 343664 kb)

Video, Online Resource 6, which shows the flap and how the strategy allows adjustment, the defect, flap inset, and final appearance just right at the end of the surgery (MPG 200060 kb)

ESM 1

Video, Online Resource 1, which shows land marks, lines, and mapped skin vessels (MPG 61502 kb)

ESM 2

Video, Online Resource 2, which shows skin vessels identification (MPG 383520 kb)

ESM 3

Video, Online Resource 3, which shows identifying source vessels by opening the intermuscular septum between the rectus femoris and the vastus lateralis muscles (MPG 234916 kb)

ESM 4

Video, Online Resource 4, which demonstrates how perforators are unroofed and dissected and the pedicle is prepared proximally and distally (MPG 364966 kb)

ESM 5

Video, Online Resource 5, which shows the posterior margin of skin flap being cut and the muscle component being dissected (MPG 343664 kb)

ESM 6

Video, Online Resource 6, which shows the flap and how the strategy allows adjustment, the defect, flap inset, and final appearance just right at the end of the surgery (MPG 200060 kb)

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Tsao, C., ALDeek, N.F. & Hung, R. “Vascular preparation first”: a valuable strategy in anterolateral thigh flap harvest. Eur J Plast Surg 36, 789–792 (2013) doi:10.1007/s00238-013-0860-1

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Keywords

  • Anterolateral thigh flap
  • Descending branch
  • Oblique branch
  • Rectus femoris
  • Vastus lateralis
  • Perforator