Clinical applications of the pedicled anterolateral thigh flap in reconstruction

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Introduction of the anterolateral thigh (ALT) flap by Song et al. in 19841 led to a revolution in reconstructive microsurgery, with the subsequent introduction of so‐called ‘perforator flaps’.2 In recent years, the free ALT flap has become a workhorse for reconstructing skin and soft‐tissue defects. Following extensive experience with free ALT flaps, Wei et al.3 characterized it as an ideal soft‐tissue flap, because of its remarkably long pedicle, reliable vascularity, tremendous versatility and the minor level of donor site morbidity. Koshima et al.4 first reported its use as a pedicled flap for the reconstruction of an extensive perineal defect. We used this flap in the reconstruction of trochanteric defects caused either by pressure sores or by osteomyelitis of the trochanter with implant extrusion.5 We refined the procedure as a modified pedicled ALT myocutaneous flap based on the descending branch of the lateral circumflex femoral artery to cover trochanteric pressure sores.6 Three cases of abdominal wall and one groin defect were also covered using pedicled ALT flaps7 and one case of a prosthesis‐exposed knee with infection was successfully reconstructed using a reversed ALT flap. We also used the pedicled ALT flap in 10 cases of penoscrotal defects because of Fournier's gangrene.8 In this series, we present our experience with the use of pedicled ALT perforator flaps to cover the defects from knee to abdomen.
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