DOI QR코드

DOI QR Code

Comparison of The Thickness of Free Anterolateral Thigh Flap in Different Fascial Planes: Clinical Results of Subfascial and Superficial Fat Flap

  • Yavuz Tuluy (Department of Plastic, Reconstructive and Aesthetic Surgery, Turgutlu State Hospital) ;
  • Zulfukar Ulas Bali (Plastic, Reconstructive and Aesthetic Surgery) ;
  • Merve Ozkaya Unsal (Department of Plastic, Reconstructive and Aesthetic Surgery) ;
  • Aziz Parspanci (Department of Plastic Reconstructive and Aesthetic Surgery, Bayburt State Hospital) ;
  • Levent Yoleri (Department of Plastic Reconstructive and Aesthetic Surgery, Manisa Celal Bayar University Faculty of Medicine) ;
  • Cagla Cicek (Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul Kartal Dr. Lutfi Kirdar City Hospital) ;
  • Gaye Taylan Filinte (Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul Kartal Dr. Lutfi Kirdar City Hospital)
  • Received : 2022.12.20
  • Accepted : 2023.06.29
  • Published : 2023.11.15

Abstract

Background The anterolateral thigh (ALT) flap is a preferred option in the reconstruction of a wide variety of defects, enabling multiple tissue components and thicknesses. Methods This study was conducted to investigate the correlation of the thickness of the traditional subfascial ALT flap and superficial fat flap with age, gender, and body mass index (BMI). A total of 42 patients (28 males and 14 females) were included in the study. Results Mean age was 50.2 (range, 16-75) years and mean BMI was 24.68 ± 4.02 (range, 16.5-34.7) kg/m2. The subfascial flap thickness was significantly thinner in male patients (16.07 ± 2.77 mm) than in female patients (24.07 ± 3.93 mm; p < 0.05), whereas no significant difference was found between male (4.28 ± 1.15 mm) and female patients (4.85 ± 1.09 mm) regarding superficial fat flap thickness (p = 0.13). The thickness of both flaps had a positive correlation with BMI, and the strongest correlation was found for subfascial ALT thickness in female patients (r = 0.81). Age had no effect on both flap thickness measurements. The anterior thigh is thicker in women than in men, although it varies according to BMI. This shows that flap elevation is important in the superthin plane, especially if a thin flap is desired in female patients in defect reconstruction with the ALT flap. Thus, a single-stage reconstruction is achieved without the need for a defatting procedure after subfascial dissection or a second defatting procedure 3 to 6 months later. Conclusion The appropriate ALT flap plane should be selected considering the gender and BMI of the patient.

Keywords

References

  1. Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984;37(02):149-159 https://doi.org/10.1016/0007-1226(84)90002-X
  2. Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002;109(07):2219-2226 https://doi.org/10.1097/00006534-200206000-00007
  3. Gong ZJ, Zhang S, Ren ZH, Zhu ZF, Liu JB, Wu HJ. Application of anteromedial thigh flap for the reconstruction of oral and maxillofacial defects. J Oral Maxillofac Surg 2014;72(06):1212-1225 https://doi.org/10.1016/j.joms.2013.11.017
  4. Koshima I, Chiu HY, Yu JC, Pan SC, Tsai ST, Shen CL. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 2000;105(07):2358-2360 https://doi.org/10.1097/00006534-200006000-00007
  5. Kimata Y, Uchiyama K, Ebihara S, et al. Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects. Arch Otolaryngol Head Neck Surg 1997;123(12):1325-1331 https://doi.org/10.1001/archotol.1997.01900120075012
  6. Gong ZJ, Wang K, Tan HY, Zhang S, He ZJ, Wu HJ. Application of thinned anterolateral thigh flap for the reconstruction of head and neck defects. J Oral Maxillofac Surg 2015;73(07):1410-1419 https://doi.org/10.1016/j.joms.2015.01.006
  7. Sun G, Lu M, Hu Q, Tang E, Yang X, Wang Z. Clinical application of thin anterolateral thigh flap in the reconstruction of intraoral defects. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115(02):185-191 https://doi.org/10.1016/j.oooo.2012.03.030
  8. Demirkan F, Chen HC, Wei FC, et al. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg 2000;53(01):30-36 https://doi.org/10.1054/bjps.1999.3250
  9. Khadakban D, Kudpaje A, Thankappan K, et al. Reconstructive indications of anterolateral thigh free flaps in head and neck reconstruction. Craniomaxillofac Trauma Reconstr 2016;9(01):40-45 https://doi.org/10.1055/s-0035-1558455
  10. De Virgilio A, Iocca O, Di Maio P, et al. Head and neck soft tissue reconstruction with anterolateral thigh flaps with various components: development of an algorithm for flap selection in different clinical scenarios. Microsurgery 2019;39(07):590-597 https://doi.org/10.1002/micr.30495
  11. Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap thinning: techniques and complications. Ann Plast Surg 2014;72(02):246-252 https://doi.org/10.1097/SAP.0b013e31825b3d3a
  12. Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg 1989; 42(03):260-262 https://doi.org/10.1016/0007-1226(89)90142-2
  13. Maruccia M, Fallico N, Cigna E, et al. Suprafascial versus traditional harvesting technique for free antero lateral thigh flap: a case-control study to assess the best functional and aesthetic result in extremity reconstruction. Microsurgery 2017;37(08):851-857 https://doi.org/10.1002/micr.30248
  14. Ross GL, Dunn R, Kirkpatrick J, et al. To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects. Br J Plast Surg 2003;56(04):409-413 https://doi.org/10.1016/S0007-1226(03)00126-7
  15. Diamond S, Seth AK, Chattha AS, Iorio ML. Outcomes of subfascial, suprafascial, and super-thin anterolateral thigh flaps: tailoring thickness without added morbidity. J Reconstr Microsurg 2018;34(03):176-184 https://doi.org/10.1055/s-0037-1607426
  16. Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg 1996;97(05):985-992 https://doi.org/10.1097/00006534-199604001-00016
  17. Kimura N, Satoh K, Hasumi T, Ostuka T. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg 2001;108(05):1197-1208 https://doi.org/10.1097/00006534-200110000-00015
  18. Seth AK, Iorio ML. Super-thin and suprafascial anterolateral thigh perforator flaps for extremity reconstruction. J Reconstr Microsurg 2017;33(07):466-473 https://doi.org/10.1055/s-0037-1601422
  19. Gong ZJ, Wu HJ. Measurement for subcutaneous fat and clinical applied anatomic studies on perforators in the anterior thigh region. J Oral Maxillofac Surg 2013;71(05):951-959 https://doi.org/10.1016/j.joms.2012.12.003
  20. Kwon JG, Brown E, Suh HP, Pak CJ, Hong JP. Planes for perforator/skin flap elevation-definition, classification, and techniques. J Reconstr Microsurg 2023;39(03):179-186 https://doi.org/10.1055/s-0042-1750127
  21. Schaverien M, Saint-Cyr M, Arbique G, Hatef D, Brown SA, Rohrich RJ. Three- and four-dimensional computed tomographic angiography and venography of the anterolateral thigh perforator flap. Plast Reconstr Surg 2008;121(05):1685-1696 https://doi.org/10.1097/PRS.0b013e31816b4587
  22. Fan S, Zhang HQ, Li QX, et al. The use of a honeycomb technique combined with ultrasonic aspirators and indocyanine green fluorescence angiography for a superthin anterolateral thigh flap: a pilot study. Plast Reconstr Surg 2018;141(06):902e-910e https://doi.org/10.1097/PRS.0000000000004411
  23. Dogan ZDA, Ozkan MC, Tuncer FB, Sacak B, Celebiler O A comparative clinical study of flap thickness: medial sural artery perforator flap versus anterolateral thigh flap. Ann Plast Surg 2018;81(04):472-474 https://doi.org/10.1097/SAP.0000000000001488
  24. Hwang K, Kim H, Kim DJ. Thickness of skin and subcutaneous tissue of the free flap donor sites: a histologic study. Microsurgery 2016;36(01):54-58 https://doi.org/10.1002/micr.30000
  25. Hsu K-C, Tsai W-H, Ting P-S, et al. Comparison between anterolateral thigh, radial forearm, and peroneal artery flap donor site thickness in Asian patients-a sonographic study. Microsurgery 2017;37(06):655-660 https://doi.org/10.1002/micr.30164
  26. Nakayama B, Hyodo I, Hasegawa Y, et al. Role of the anterolateral thigh flap in head and neck reconstruction: advantages of moderate skin and subcutaneous thickness. J Reconstr Microsurg 2002;18(03):141-146 https://doi.org/10.1055/s-2002-28463
  27. Suh YC, Kim SH, Baek WY, Hong JW, Lee WJ, Jun YJ. Super-thin ALT flap elevation using preoperative color doppler ultrasound planning: identification of horizontally running pathway at the deep adipofascial layers. J Plast Reconstr Aesthet Surg 2022;75(02):665-673 https://doi.org/10.1016/j.bjps.2021.09.051
  28. Kim SY, Lee YJ, Mun GH. Anatomical understanding of target subcutaneous tissue layer for thinning procedures in thoracodorsal artery perforator, superficial circumflex iliac artery perforator, and anterolateral thigh perforator flaps. Plast Reconstr Surg 2018;142(02):521-534 https://doi.org/10.1097/PRS.0000000000004619
  29. Cha HG, Hur J, Ahn C, Hong JPJ, Suh HP. Ultra-thin anterolateral thigh free flap: an adipocutaneous flap with the most superficial elevation plane. Plast Reconstr Surg 2023;152(04):718e-723e https://doi.org/10.1097/PRS.0000000000010295