VERSATILITY OF

ANTEROLATERAL THIGH

FREE FLAP

N. Rajacic MD

Al –Seef hospital Kuwait

mmmmmmmmmmm

4

FLAP SELECTION

Recipient site requirements

Availability

Familiarity

FREE FLAPS

• GROIN

• LATISSIMUS DORSI

• SCAPULAR AND P.SCAPULAR FLAP

• RADIAL AND ULNAR FOREARM

• DELTOID FLAP

• LATERAL ARM

• TRAM

• TFL

• DORSALIS PEDIS

• …

TEMPORALIS FASCIA

SERRATUS FASCIA

FIBULA FLAP

ILIAC CREST

JEJUNAL FLAP

OMENTAL FLAP …

ANTEROLATERAL THIGH FLAP

SONG 1984

Fu-Chan-Wei

Koshima

VASCULAR ANATOMY

DESCENDING BRANCH OF LCFA

SEPTOCUTANEOUS PERFORATORS (12-32%) MUSCULOCUTANEOUS PERFORATORS

LCFA

Descending branch

Transverse branch

Nerve for m. Vastus lat.

m. Vastus. lat

m. Rectus femoris

Descending branch LCFA

Septocutaneous branch LCFA

descending branch LCFA

Septocutaneous branch

m. Rectus femoris

m. Vastus lateralis

Descending branch of LCFA

Perforating branch

Musculocutaneous perforators

PREOPERATIVE REQUIREMENT

•NO NEED OF ANGIOGRAPHY

•DETECTION OF PERFORATOR BY DOPPLER FLOWMETER IS

ESSENTIAL

Spina iliaca

anterior superior

Patella

PLANING OF

THE FLAP

COMPOSITION

MUSCLE

MUSCLE +SKIN

FASCIOCUTANEOUS

ULTRATHIN SKIN

FLOW-THROUGH FLAP

FUNC. MUSCLE TRANSFER

VASC. NERVE GRAFT

MUSCLE FLAP

TFL

m. Rectus femoris

m. Vastus lat.

MYOCUTANEOUS FLAP

FASCIOCUTANEOUS FLAP

PLANE OF DISSECTION

ULTRATHIN SKIN FLAP

THINING OF THE FLAP

0,5 cm

DEEPITHELIASATION

SHAPING OF THE FLAP

OUTER

COVER

INNER LINING

FUNCTIONAL MUSCLE TRANSFER

Combined flap- chimeric principle

FLOW-THROUGH FLAP

Vascularised nerve graft

• SAFE AND EASY ELEVATION

• LONG VASCULAR PEDICLE (10-12cm)

• LARGE CALIBER VESSEL (2mm)

• LARGE DONOR FLAP AREA (30X18cm)

• POSSIBILITY OF THINNING THE

FLAP

• MINIMAL DONOR SITE MORBIDITY

• POSSIBILITY OF MULTIPLE FLAPS ON

THE SAME PEDICLE (CHIMERIC

PRINCIPLE)

• NO NEED TO CHANGE POSITION OF

THE PATINET (SUPINE POSITION)

• VARIABLE ANATOMY

• DONOR SITE GRAFTING IN CASE OF

LARGE FLAPS ( MORE THAN 10 cm)

• HAIRY SKIN IN MALES

ADVANTAGES DISADVANTAGES

ANTEROLATERAL FLAP IS EXTREMELY

RELIABLE FLAP FOR THE RECONSTRUCTIONS OF

VARIOUS DEFECTS DUE TO GOOD LENGTH AND

SIZE OF PEDICLE, LARGE AMOUNT OF TISSUE OF

DESIRABLE THICKNESS AND COMPOSITION ,

EASY DISSECTION AND MINIMAL DONOR SITE

MORBIDITY

CONCLUSION