Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction

Background The anterolateral thigh (ALT) flap remains a workhorse for soft tissue reconstruction. However, the traditional ALT flap is often too bulky for resurfacing shallow, distal extremity defects, prohibiting adequate function, or well-fitted orthotics. This study evaluates extremity reconstruction using ALT flaps elevated in the suprafascial or super-thin plane. Methods Retrospective review of ALT free flap reconstruction from October 2014 to July 2016 was performed. Suprafascial and super-thin flaps were those elevated just above the crural fascia and within the superficial scarpal plane, respectively. Adjunct operative procedures, demographics, and complications were recorded. Results A total of 25 patients underwent suprafascial ( n =14) or super-thin ( n =11) ALT flap reconstruction for primarily lower extremity wounds ( n =19), with an average age and body mass index of 53.8 years and 26.3 kg/m (2) , respectively. Follow-up was 6.3 months. Comorbidities included smoking ( n =7), diabetes ( n =8), peripheral vascular disease ( n =6), and hypertension ( n =8). The presence of hardware ( n =9), trauma ( n =10), and chronic infection ( n =12) were common risk factors. Average flap size was 8.2 x 21.5 cm, with 64% ( n =16) taken on one perforator. Forty-eight percent ( n =12) were end-to-side anastomoses and 62% ( n =13) utilized one venous anastomosis. Mean hospital stay was 7.8 days with a 24% ( n =6) complication rate. There were no partial or complete flap losses. Conclusion The ALT flap, elevated in a suprafascial or super-thin plane, is a safe, effective option for extremity soft tissue reconstruction. The decreased flap volume and bulk provides the improved contour and pliability necessary for appropriate distal extremity function. The potential versatility of super-thin flaps reinforces the importance of continued innovation by reconstructive microsurgeons.