The reconstruction of large, complex defects of the abdominal wall after the ablation of malignant tumours can be challenging. The transfer of an anterolateral thigh (ALT) flap is an attractive option. This study compared free ALT flaps and pedicled ALT flaps for abdominal wall reconstruction.
From 1996 through 2011, 20 patients underwent abdominal wall reconstruction with ALT flaps. The flaps were pedicled in 12 patients and free in eight patients. Medical records were reviewed for complications and clinical and demographic data. Abdominal wall defects were classified into the following four groups: upper midline, lower midline, upper quadrants and lower quadrants.
Pedicled flaps were transferred to the upper midline region in one patient, the lower midline region in six patients and lower quadrants in five patients. Free flaps were transferred to the lower midline region in two patients, upper quadrants in four patients and lower quadrants in two patients. Mean reconstructive time was significantly longer with free flaps (6 h 32 min) than with pedicled flaps (4 h 55 min, p = 0.035). Although free flaps (mean size, 360 cm2) were larger than pedicled flaps (mean size, 289 cm2), the difference was not significant (p = 0.218). The rates of complications did not differ between free flaps and pedicled flaps. No total flap loss occurred, and there was partial loss of only a single pedicled flap, which was the flap furthest from the pivot point. Infections developed of two pedicled flaps and three free flaps.
This study suggests that complication rates do not differ between free and pedicled ALT flaps. The choice of flap depends on the size and location of the defect and the length of the vascular pedicle.
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- Complex abdominal wall reconstruction: a comparison of flap and mesh closure.Ann Surg. 2000; 232: 586-596
- Reconstruction of complex abdominal wall defects with free flaps: indications and clinical outcome.Plast Reconstr Surg. 2009; 124: 500-509
- Erratum to: immediate repair of major abdominal wall defect after extensive tumor excision in patients with abdominal wall neoplasm: a retrospective review of 27 cases.Ann Surg Oncol. 2009;
- Anterolateral thigh flap for abdominal wall reconstruction.Plast Reconstr Surg. 1999; 103: 1191-1197
- Versatility of the proximally pedicled anterolateral thigh flap and its use in complex abdominal and pelvic reconstruction.Plast Reconstr Surg. 2011; 127: 677-688
- Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps.Plast Reconstr Surg. 2002; 109 (discussion 2227–30): 2219-2226
- Anterolateral thigh flap for postmastectomy breast reconstruction.Plast Reconstr Surg. 2002; 110: 82-88
- The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity.Plast Reconstr Surg. 2005; 115: 142-147
- The anterolateral thigh free flap for skull base reconstruction.Otolaryngol Head Neck Surg. 2009; 140: 855-860
- Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects.Arch Otolaryngol Head Neck Surg. 1997; 123: 1325-1331
- Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation.Plast Reconstr Surg. 2000; 105: 2358-2360
- Versatility of the anterolateral thigh flap with Vascularized fascia Lata for reconstruction of complex soft-tissue defects: clinical experience and Functional assessment of the donor site.Plast Reconstr Surg. 2009; 124: 171-180
- Anterolateral thigh free flap for complex composite central chest wall defect reconstruction with extrathoracic microvascular anastomoses.Plast Reconstr Surg. 2010; 126: 1581-1588
- Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases.Plast Reconstr Surg. 1998; 102: 1517-1523
- The anterolateral thigh flap; variations in its vascular pedicle.Br J Plast Surg. 1989; 42: 260-262
- The distribution of the perforators in the anterolateral thigh and the utility of multidetector row computed tomography angiography in preoperative planning.Ann Plast Surg. 2010; 65: 155-160
- Preoperative assessment of anterolateral thigh flap cutaneous perforators by colour Doppler flowmetry.Br J Plast Surg. 2003; 56: 21-25
- Why not perforator flap training models in rats?.J Plast Reconstr Aesthet Surg. 2009; 63: e134-e135
Published online: May 30, 2012
Accepted: May 3, 2012
Received: February 17, 2012
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.