Zusammenfassung
Hintergrund
Seit 2005 wird der freie anterolaterale Oberschenkellappen (ALT) zur Defektdeckung im Bereich der oberen und unteren Extremität in unserer Klinik eingesetzt. Die Indikationen für den Lappentransfer sind vielfältig und umfassen u. a. posttraumatische Defekte, Defekte infolge von akuten und chronischen Infektionen und Weichteildefekte nach onkologischen Resektionen.
Patienten
Das Patientenkollektiv umfasste 58 Patienten, die im Zeitraum von Januar 2005 bis März 2007 60 ALT-Lappen in mikrochirurgischer Technik erhielten. Wir operierten 19 Frauen und 39 Männer mit einem Durchschnittsalter von 50,9 (16–84) Jahren.
Ergebnisse
Es kam insgesamt zu 3 kompletten Lappenverlusten (5%). Bei 35,0% Patienten konnten wir Majorkomplikationen dokumentieren. Dazu zählten Anastomosenrevisionen (20%) und partielle Lappennekrosen (10%). Minorkomplikationen wie Schwellung (3,3%), Wundheilungsstörungen (23,3%) und Hämatome (11,7%) traten bei 38,3% der Patienten auf. Die Operationsdauer betrug im Durchschnitt 282 (69–544) min.
Schlussfolgerung
Die Analyse der ersten 60 ALT-Lappenplastiken nach intra- und postoperativen Komplikationen zeigte, dass der ALT-Lappen Vorteile gegenüber anderen Lappenplastiken hat und nicht mehr aus unserem klinischen Alltag wegzudenken ist.
Abstract
Background
The anterolateral thigh flap (ALT) has become one of the most preferred options for soft tissue defect reconstruction in Asia with an increasing popularity in Europe. The article presents the authors’ experience using the ALT flap for various indications in the upper and lower extremities.
Methods
Between January 2005 and March 2007, 60 free ALT flaps were operated for reconstruction of various soft tissue defects. The causes of soft tissue defects included trauma (13), infection (26), and sarcoma resection (21). We operated on 39 male and 19 female patients with an average age of 50.9 years (range: 16–84 years).
Results
The flap survival rate was 95.0% percent (57 of 60 flaps); 5% of the flaps died. The donor site was closed primarily in all cases. Donor site complications were minimal. The average operative time was 282 min (69–544 min). Flap-related major complications occurred in 35.0% of patients including reexploration of the anastomoses and partial flap necrosis. Minor complications, e.g., wound infection, hematoma, and swelling were seen in 23 cases.
Conclusions
Our experience indicates that the free ALT flap is a reliable method for soft tissue defect reconstruction. The use of the ALT offers many advantages such as a long and large caliber vascular pedicle, a large skin island as well as minimal donor site morbidity. The surgery can simultaneously performed by two teams with the patient in a supine position.
Literatur
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: 149–159
Wei FC, Celik N, Jeng SF (2005) Application of „simplified nomenclature for compound flaps“ to the anterolateral thigh flap. Plast Reconstr Surg 115: 1051–1057
Lewin JS, Reece G, Robb G et al. (2006) Functional outcomes after laryngopharyngectomy with anterolateral thigh flap reconstruction. Head Neck 28: 142–149
Felici N, Felici A (2006) A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg 59: 153–157
Guerra AB et al. (2004) The thoracodorsal artery perforator flap: clinical experience and anatomic study with emphasis on harvest techniques. Plast Reconstr Surg 114: 32–43
Kuo YR, Kuo MH, Chou WC et al. (2004) One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata. Ann Surg 239: 352–358
Yang JY, Tsai FC, Chana JS et al. (2002) Use of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of postburn anterior cervical contractures. Plast Reconstr Surg 110: 39–46
Chen HC, Tang YB (2003) Anterolateral thigh flap: an ideal soft tissue flap. Clin Plast Surg 30: 383–401
Rajacic N, Gang RK, Krishnan J et al. (2002) Thin anterolateral thigh free flap. Ann Plast Surg 48: 252–257
Ceulemans P, Hofer SO (2004) Flow-through anterolateral thigh flap for a free osteocutaneous fibula flap in secondary composite mandible reconstruction. Br J Plast Surg 57: 358–361
Chana JS, Wei FC (2004) A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg 57: 603–609
Ozkan O, Coskunfirat OK, Ozgentas HE (2004) The use of free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities. Ann Plast Surg 53: 455–461
Heller F, Lo F, Liouet LJ al. (2004) Anterolateral thigh fasciocutaneous flap for simultaneous reconstruction of refractory scalp and dural defects. Report of two cases. J Neurosurg 100: 1094–1097
Yildirim S (2006) Free flap choice for soft tissue reconstruction of the severely damaged upper extremity. J Reconstr Microsurg 22: 599–609
Yu P, Youssef A (2006) Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg 118: 928–935
Davidge K et al. (2006) Use of the anterolateral thigh flap as an alternative to the rectus flap in obese and overweight patients. Ann Plast Surg 56: 536–539
Verhelle N, Vranckx J, Van den Hof B et al. (2005) Bone exposure in the leg: is a free muscle flap mandatory? Plast Reconstr Surg 116: 170–181
Hong JP, Shin HW, Kim JJ et al. (2005) The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity. Plast Reconstr Surg 115: 142–147
Gonzalez MH, Weinzweig N (2005) Muscle flaps in the treatment of osteomyelitis of the lower extremity. J Trauma 58: 1019–1023
Van Landuyt K, Blondeel P, Hamdi M et al. (2005) The versatile DIEP flap: its use in lower extremity reconstruction. Br J Plast Surg 58: 2–13
Koshima I, Yamashita S, Sugiyama N et al. (2005) Flow-through anterior thigh flaps with a short pedicle for reconstruction of lower leg and foot defects. Plast Reconstr Surg 115: 155–162
Koshima I, Nanba Y, Tsutsui T et al. (2003) New anterolateral thigh perforator flap with a short pedicle for reconstruction of defects in the upper extremities. Ann Plast Surg 51: 30–36
Gravvanis AI, Tsoutsos DA, Karakitsos D (2006) Application of the pedicled anterolateral thigh flap to defects from the pelvis to the knee. Microsurgery 26: 432–438
Zhang Q, Qiao Q, Chen G (2006) Clinical application of the anterolateral thigh flap in 112 patients. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 20: 540–543
Mutaf M, Isik D, Bulut O et al. (2006) A true one-stage nonmicrosurgical technique for total phallic reconstruction. Ann Plast Surg 57: 100–106
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Langer, S., Steinsträßer, L., Lehnhardt, M. et al. Der freie ALT-Oberschenkellappen in der traumatologischen und onkologischen Defektdeckung. Unfallchirurg 111, 323–330 (2008). https://doi.org/10.1007/s00113-007-1355-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00113-007-1355-y
Schlüsselwörter
- ALT-Oberschenkellappen
- Traumatologische und onkologische Defektdeckung
- Obere und untere Extremität
- Lappenverlust