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Primary thinning of the anterolateral thigh flap in Caucasians is a safe technique

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Abstract

Background

The anterolateral thigh (ALT) perforator flap is a well-described and versatile flap, regularly used for resurfacing and reconstructing soft tissue defects, but it is often too bulky to produce an aesthetically satisfactory result. Although primary thinning of the ALT has been successful in Eastern populations, studies have demonstrated that this may be inadvisable in Caucasians. This is the biggest clinical study demonstrating the clinical safety of primary thinning of ALT flaps in Caucasians.

Methods

A retrospective analysis was performed between January 2009 and August 2011 on 57 patients (mean age 43) undergoing ALT free flap reconstruction by three surgeons. They were all thinned via sharp dissection using loupe magnification except for 1–2 cm around the perforator by removing the larger fat globules of deep fascia and preserving the superficial fat layer. The resultant flap thickness was approximately 6 mm.

Results

In 77 % of cases, the flap was used for lower limb, 16 % for upper limb and 7 % for head and neck reconstruction. The mean flap surface area was 124 cm2. There was one flap loss (1.8 %) and three flaps returned to theatre for perioperative complications.

Conclusions

Careful primary thinning of ALT flaps is safe in Caucasian populations and can achieve improved cosmetic results.

Level of Evidence: Level IV, risk/prognostic study.

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References

  1. 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

    Article  CAS  PubMed  Google Scholar 

  2. Askouni EP, Topping A, Jain A et al (2012) Outcomes of anterolateral thigh free flap thinning liposuction following lower limb trauma. J Plast Reconstr Aesthet Surg 65(4):474–481

    Article  PubMed  Google Scholar 

  3. Yang WG, Chiang YC, Wei FC et al (2006) Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing. Plast Reconstr Surg 117:1004–1008

    Article  CAS  PubMed  Google Scholar 

  4. Koshima I, Fukuda H, Yamamoto H et al (1993) Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 92:421–428

    Article  CAS  PubMed  Google Scholar 

  5. Rajacic N, Gang RK, Krishnan J et al (2002) Thin anterolateral thigh free flap. Ann Plast Surg 48:252–257

    Article  PubMed  Google Scholar 

  6. Kimura N, Satoh K (1996) Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg 97:985

    Article  CAS  PubMed  Google Scholar 

  7. Kimura N, Satoh K, Hasumi T, Otsuka T (2001) Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg 108:1197

    Article  CAS  PubMed  Google Scholar 

  8. Alkureishi LW, Shaw-Dunn J, Ross GL (2003) Effects of thinning the anterolateral thigh flap on the blood supply to the skin. Br J Plast Surg 56:401–408

    Article  CAS  PubMed  Google Scholar 

  9. Schaverien M, Saint-Cyr M, Arbique G et al (2008) Three- and four-dimensional computed tomographic angiography and venography of the anterolateral thigh perforator flap. Plast Reconstr Surg 121:1685–1696

    Article  CAS  PubMed  Google Scholar 

  10. Sharabi SE, Hatef DA, Koshy JC et al (2010) Is primary thinning of the anterolateral thigh flap recommended? Ann Plast Surg 65(6):555–559

    Article  CAS  PubMed  Google Scholar 

  11. Spyriounis PK (2006) The extended approach to the vascular pedicle of the anterolateral thigh perforator flap: anatomical and clinical study. Plast Reconstr Surg 117(3):997–1001

    Article  CAS  PubMed  Google Scholar 

  12. Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K (1998) Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 102:1517

    Article  CAS  PubMed  Google Scholar 

  13. Xu D-C, Zhong S-Z, Kong J-M et al (1988) Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg 82:306

    Google Scholar 

  14. Zhou G, Qiao Q, Chen Y, Ling YC, Swift R (1991) Clinical experience and surgical anatomy of 32 free anterolateral thigh flap transplantations. Br J Plast Surg 44:91

    Article  CAS  PubMed  Google Scholar 

  15. Luo S, Raffoul W, Luo J et al (1999) Anterolateral thigh flap: a review of 168 cases. Microsurgery 19:232

    Article  CAS  PubMed  Google Scholar 

  16. Townley WA, Royston EC, Karmiris N, Crick A, Dunn RL (2011) Critical assessment of the anterolateral thigh flap donor site. J Plast Reconstr Aesthet Surg 64(12):1621–1626

    Article  CAS  PubMed  Google Scholar 

  17. Lipa JE, Novak CB, Binhammer PA (2005) Patient-reported donor-site morbidity following anterolateral thigh free flaps. J Reconstr Microsurg 21(6):365–370

    Article  PubMed  Google Scholar 

  18. Deurenberg P, Yap M, van Staveren WA (1998) Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord 22(12):1164–1171

    Article  CAS  PubMed  Google Scholar 

  19. Koshima I (2000) Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 105:2358

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. Koshima I, Fujitsu M, Ushio S 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

    CAS  PubMed  Google Scholar 

  22. Koshima I, Hosoda M, Moriguchi T et al (2000) New multilobe “accordion” flaps for three-dimensional reconstruction of wide, full-thickness defects in the oral floor. Ann Plast Surg 45:187–192

    Article  CAS  PubMed  Google Scholar 

  23. Ross GL, Dunn R, Kirkpatrick J et al (2003) To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects. Br J Plast Surg 56:409

    Article  CAS  PubMed  Google Scholar 

  24. Loreti A, DeLella G, Vetrano S et al (2008) Thinned anterolateral thigh cutaneous flap and radial fasciocutaneous forearm flap for reconstruction of oral defects: comparison of donor site morbidity. J Oral Maxillofac Surg 66:1093–1098

    Article  PubMed  Google Scholar 

  25. Adani R, Tarallo L, Marcoccio I et al (2005) Hand reconstruction using the thin anterolateral thigh flap. Plast Reconstr Surg 116:467–473

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

I would like to express my gratitude to Ms. Caroline McGuiness and Mr. Naveen Cavale, consultant plastic surgeons, because they provided me important data for this study.

Conflict of Interest

None

Ethical Standards

The study has been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study were omitted.

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Authors and Affiliations

  1. Department of Burns, Plastic and Reconstructive Surgery, Odstock Centre, Salisbury, Wiltshire, UK

    Nikolaos Ioannis Karmiris, Marios Nicolaou & Mansoor S. Khan

Authors
  1. Nikolaos Ioannis Karmiris
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  2. Marios Nicolaou
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  3. Mansoor S. Khan
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Correspondence to Nikolaos Ioannis Karmiris.

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Karmiris, N.I., Nicolaou, M. & Khan, M.S. Primary thinning of the anterolateral thigh flap in Caucasians is a safe technique. Eur J Plast Surg 37, 437–442 (2014). https://doi.org/10.1007/s00238-014-0955-3

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  • DOI: https://doi.org/10.1007/s00238-014-0955-3

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