Anterolateral Thigh Flap for Reconstruction of an Oropharyngectomy Defect

摘要

INTRODUCTION The anterolateral thigh (ALT) flap has become the workhorse flap for soft-tissue reconstruction of head and neck defects.1 This perforator-based fasciocutaneous flap is ideal due to its thin, pliable nature and long vascular pedicle. It can include the vastus lateralis muscle for added bulk or tensor fasciae latae for strength, or can be thinned to skin and subcutaneous fat.1 The vascular pedicle supply is the descending branch of the lateral circumflex femoral artery with a length as long as 18 cm.2 Up to 10 × 25 cm of skin paddle can be harvested without compromising closure of the donor site.3 It can also be made into a sensate flap via the anterior branch of the lateral cutaneous nerve of the thigh.2 It results in minimal donor site morbidity when harvested in either the sub- or suprafascial plane, without functional muscle loss.4 Finally, the ALT also allows for a two-team surgical approach, yielding a more efficient operative experience for the patient and surgeons involved. (See Video 1 [online], which displays introduction and indications for an anterolateral thigh flap for head and neck reconstruction.) {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"ALT introductions and indications. Video 1 from “Anterolateral Thigh Flap (ALT) for Reconstruction of an Oropharyngectomy Defect.” This video displays the introduction and indications for an anterolateral thigh flap for head and neck reconstruction.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_isjptaac"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} PREOPERATIVE MARKINGS Skin perforators for the ALT flap vary from one to three perforators and should be localized with a Doppler before anesthesia induction and its associated hypotension. Perforators are often located approximately midway on a line drawn from the anterior-superior iliac spine to the lateral patella, corresponding to the septum between the rectus femoris and vastus lateralis muscles.5 The flap is then drawn as an ellipse, to match the required defect size, often centering the ellipse over the strongest Dopplerable perforator(s). (See Video 2 [online], which displays patient case report presentation with demonstration of anterolateral thigh flap preoperative markings and initial flap dissection.) {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 2.","caption":"Patient case report presentation. Video 2 from “Anterolateral Thigh Flap (ALT) for Reconstruction of an Oropharyngectomy Defect.” This video displays the patient case report presentation with demonstration of anterolateral thigh flap pre-operative markings and initial flap dissection.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_ctj2uxue"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} FLAP HARVEST AND MICROSURGERY Perforator harvest of the ALT requires meticulous intramuscular dissection to follow the perforator from the skin to its main vascular pedicle, which is demonstrated in vivid detail in the educational video included in this article. (See Video 3 [online], which displays intramuscular perforator dissection and microsurgical technique for the anterolateral thigh flap.) {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 3.","caption":"Microsurgical technique. Video 3 from “Anterolateral Thigh Flap (ALT) for Reconstruction of an Oropharyngectomy Defect.” This video demonstrates intramuscular perforator dissection and microsurgical technique for the anterolateral thigh flap.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream