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The extended pedicle anterolateral thigh flap and its application in scalp reconstruction.
Lamaris GA, Knackstedt R, Abedi N, Gastman B
University
2016-02-15
Presenter: Lamaris GA
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction
Large soft tissue defects of the scalp can present difficulties in reconstruction. The ideal flap for scalp reconstruction has yet to be described although the latissimus dorsi flap is frequently referred to as the first choice for reconstruction.
Patients and Methods
Following institutional review board approval, we reviewed our experience in scalp, maxillary and base of skull microsurgical reconstruction in the past 4 years. Patient demographics, indication for reconstruction, flap choice, complications as well as long term outcome were recorded.
Results
A total of 24 patients underwent anterolateral thigh free flap for maxillary and base of skull reconstruction as well scalp coverage. In the majority of cases the indication for reconstruction was resection of a cutaneous malignancy. In most cases the facial artery and vein were used for anastomosis, while the superficial temporal vessels were used only in two cases. None of the cases required the use of vein grafts to increase pedicle length. One of 24 flaps failed and required salvage reconstruction with a latissimus dorsi flap.
Discussion
The anterolateral thigh flap can emerge as a viable alternative to the latissimus dorsi flap in scalp reconstruction, obviating the need for vein grafting even when the proximal neck vessels are used as the recipient targets. The anterolateral thigh flap can provide a durable skin island that can withstand adjuvant radiation and can simplify monitoring for tumor recurrences. This is the first study highlighting the ALT flap as a bone fide alternative to the LD in scalp reconstruction.
