Skip to main content

Advertisement

SpringerLink
Log in

Use of Free Anterolateral Thigh Flap in Reconstruction of Soft Tissue Defects in Orthopedic Oncology: What are the Outcomes?

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Introduction

Soft tissue defects due to trauma with crush injuries and post-tumor excision are large in size. Free anterolateral flap provides a stable and durable coverage of soft tissue defects and leads to good functional outcomes.

Materials and Methods

Between January 2017 and January 2019, eight males and six female patients with soft tissue defects were operated upon using a free anterolateral thigh flaps. The defects in ten patients were due to post-tumor extirpation and in four patients due to wound breakdown following post-tumor extirpation.

Results

The average flap dimension was 14 cm × 12 cm. The mean follow-up was 11 months (4–28 months). All the flaps survived well except in one patient who with an upper limb defect, had flap necrosis owing to which patient needed to undergo abdominal flap coverage. Two patients with sarcoma developed local recurrence and had to undergo above‑knee amputation.

Conclusion

The method of reconstruction depends on the size of defect and area to be covered and need of post-surgery mobilization and need for radiotherapy. The free anterolateral thigh flap has varied uses in orthopedics with very good extent of coverage and provides very potent coverage of neurovascular structures, bones, tendons, and implants.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Song, Y. G., Chen, G. Z., & Song, Y. L. (1984). The free thigh flap: A new free flap concept based on the septocutaneous artery. British Journal of Plastic Surgery, 37(2), 149–159.

    Article  CAS  Google Scholar 

  2. Kimata, Y., Uchiyama, K., Ebihara, S., et al. (1997). Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Archives of Otolaryngology - Head and Neck Surgery, 123(12), 1325–1331.

    Article  CAS  Google Scholar 

  3. Lee, Y.-C., Chiu, H.-Y., & Shieh, S.-J. (2011). The clinical application of anterolateral thigh flap. Plastic Surgery International, 2011, 127353.

    Article  Google Scholar 

  4. Xu, A.C., Koshima, I. (1996). The Anterolateral thigh flap. In: Saunders, W.B. (ed) Donald Serafin’s Atlas of Microsurgical composite tissue transplantation (1st edn, pp. 421–432). London: Elsevier Health Sciences.

  5. Begue, T., & Masquelet, A. C. (2009). Anterolateral thigh flap. In: Grabb’s Encyclopedia of Flaps (3rd ed., pp. 1495–1497). Philadelphia: Lippincott Williams & Wilkins.

    Google Scholar 

  6. Agostini, T., Lazerri, D., & Spinelli, G. (2014). Anterolateral thigh flap thinning. Techniques and complications. Annals of Plastic Surgery, 72(2), 246–252.

    Article  CAS  Google Scholar 

  7. Barclay, T. L., Cardoso, E., & Sharpe, D. T. (1983). Cross leg fasciocutaneous flaps. Plastic Reconstructive Surgery, 72, 847.

    Article  Google Scholar 

  8. Wettstein, R., Schurch, R., Banic, A., Erni, D., & Harder, Y. (2008). Review of 197 consecutive free flaps in the lower extremity. Journal of Plastic, Reconstructive and Aesthetic Surgery, 61(7), 772–776.

    Article  Google Scholar 

  9. Agarwal, P., & Raza, H. K. T. (2008). Cross Leg Flap: Its role in salvage. Indian Journal of Orthopaedics, 42(4), 439–443.

    Article  Google Scholar 

  10. Krishnamoorthy, R., & Karthikeyan, G. (2011). Degloving injuries of the hand. Indian Journal of Plastic Surgery., 4(2), 227–236.

    Google Scholar 

  11. Pai, V., Puri, A., Epali, S., & Gulia, A. (2015). Iatrogenic implantation of soft tissue sarcoma at skin graft donor site: Delayed manifestation of an avoidable complication. South Asian Journal of Cancer, 4(2), 100–101.

    Article  Google Scholar 

  12. Demirtas, Y., Kehlametoglu, O., & Cifci, M. (2010). Comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction of lower extremity. Microsurgery, 30(1), 24–31.

    PubMed  Google Scholar 

  13. Gedebou, T. M., Wei, F. C., & Lin, C. H. (2002). Clinical experience of 1284 free anterolateral thigh flaps. Handchirurgie Mikrochirurgie Plastische Chirurgie, 34(4), 239–244.

    Article  CAS  Google Scholar 

  14. Özkan, Ö., Coskunfirat, O. K., & Özgentas, H. E. (2004). The use of free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities. Annals of Plastic Surgery, 53(5), 455–461.

    Article  Google Scholar 

  15. Keshk, T. F., El Kashty, S. M., Taalab, A. A., & El-Nahas, M. A. (2018). Reconstruction of complex soft tissue defects in the lower extremities with free anterolateral thigh perforator flap. Menoufia Medical Journal, 31(4), 1386.

    Google Scholar 

  16. Demirtas, Y., Kelahmetoglu, O., Cifci, M., Tayfur, V., Demir, A., & Guneren, E. (2010). Comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction of lower extremity. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery, 30(1), 24–31.

    Google Scholar 

  17. Diamond, S., et al. (2018). Outcomes of subfascial, suprafascial, and super-thin anterolateral thigh flaps: Tailoring thickness without added morbidity. Journal of Reconstructive Microsurgery, 34(3), 176–184.

    Article  Google Scholar 

  18. Seth, A. K., & Iorio, M. L. (2017). Super-thin and suprafascial anterolateral thigh perforator flaps for extremity reconstruction. Journal of Reconstructive Microsurgery, 33(7), 466–473.

    Article  Google Scholar 

  19. Townley, W. A., Royston, E. C., & Karmiris, N. (2011). Critical assessment of the anterolateral thigh flap donor site. Journal of Plastic, Reconstructive and Aesthetic Surgery, 64(12), 1621–1626.

    Article  CAS  Google Scholar 

  20. Addison, P. D., Lannon, D., & Neligan, P. C. (2008). Compartment syndrome after closure of the anterolateral thigh flap donor site: A report of two cases. Annals of Plastic Surgery, 60(6), 635–638.

    Article  CAS  Google Scholar 

  21. Rodriguez, E. D., et al. (2007). Does fascia lata repair facilitate closure and does it affect compartment pressures of the anterolateral thigh flap donor site? Plastic and Reconstructive Surgery, 120(5), 1300–1304.

    Article  CAS  Google Scholar 

  22. Agostini, T., Lazzeri, D., & Spinelli, G. (2013). Anterolateral thigh flap: Systematic literature review of specific donor-site complications and their management. Journal of Cranio-Maxillofacial Surgery, 41(1), 15–21.

    Article  Google Scholar 

  23. Pisters, P. W., Leung, D. H., Woodruff, J., Shi, W., & Brennan, M. F. (1996). Analysis of prognostic factors in 1041 patients with localized soft tissue sarcomas of the extremities. Journal of Clinical Oncology, 14, 1679.

    Article  CAS  Google Scholar 

  24. American Joint Committee on Cancer. (2010). Soft tissues. In I. D. Fleming, J. S. Cooper, & D. E. Henson (Eds.), AJCC cancer staging manual. 7 (pp. 149–156). Philadelphia: Lippincott-Raven.

    Google Scholar 

  25. Lehnardt, M., Kuhnen, C., Drücke, D., Homann, H. H., Joneidi Jafari, H., & Steinau, H. U. (2004). Liposarcoma of the extremities: Recent developments in surgical therapy/analysis of 167 patients. Chirurg, 75(12), 1182–1190. https://doi.org/10.1007/s00104-004-0900-2.

    Article  Google Scholar 

  26. López, J. F., Hietanen, K. E., Kaartinen, I. S., Kääriäinen, M. T., Pakarinen, T. K., Laitinen, M., et al. (2015). Primary flap reconstruction of tissue defects after sarcoma surgery enables curative treatment with acceptable functional results: a 7-year review. BMC Surgery, 15(1), 71.

    Article  Google Scholar 

  27. Ng, R. W., Chan, J. Y., & Mok, V. (2008). A modification of technique to cover a large posterior thigh defect using an anterolateral thigh flap. Annals of Plastic Surgery, 61, 201–203.

    Article  CAS  Google Scholar 

  28. Radtke, C., Panzica, M., Dastagir, K., Krettek, C., & Vogt, P. M. (2015). Soft tissue coverage of the lower limb following oncological surgery. Frontiers in Oncology, 5, 303. https://doi.org/10.3389/fonc.2015.00303.

    Article  PubMed  Google Scholar 

  29. Azadgoli, B., Carre, A. L., Perrault, D. P., & Wong, A. K. (2018). Complex reconstruction of the lower extremity following sarcoma resection: a literature review. Plastic and Aesthetic Research, 5, 3. https://doi.org/10.20517/2347-9264.2017.32.

    Article  Google Scholar 

Download references

Funding

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Author information

Authors and Affiliations

  1. Divine Plastic Cosmetic Surgery Centre, Ahmdedabad, Gujarat, India

    Harshvardhan Sahijwani & Pramod Menon

  2. Department of Surgical Oncology, The Gujarat Cancer Research Institute (GCRI), Ahmdedabad, Gujarat, India

    Abhijeet Ashok Salunke & Vikas Warikoo

  3. Osteocare OrthoOnco Centre, Ahmdedabad, Gujarat, India

    Jaymin Shah

  4. Pramukswami Medical College, Karamsasd, Gujarat, India

    Prashant Moon

  5. Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, India

    Subodh Pathak

Authors
  1. Harshvardhan Sahijwani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abhijeet Ashok Salunke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vikas Warikoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pramod Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jaymin Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Prashant Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Subodh Pathak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abhijeet Ashok Salunke.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Standard Statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed Consent

For this type of study informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sahijwani, H., Salunke, A.A., Warikoo, V. et al. Use of Free Anterolateral Thigh Flap in Reconstruction of Soft Tissue Defects in Orthopedic Oncology: What are the Outcomes?. JOIO 55 (Suppl 1), 246–255 (2021). https://doi.org/10.1007/s43465-020-00208-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-020-00208-1

Keywords

Search

Navigation