Perforator-to-perforator musculocutaneous anterolateral thigh flap for reconstruction of a lumbosacral defect using the lumbar artery perforator as recipient vessel.
ABSTRACT Reconstruction of large-sized lumbosacral or sacral defects often is not possible using local or regional flaps, making the use of free flaps necessary. However, the difficulty of any microsurgical procedure in this region is complicated by the need to search for potential recipient vessels to revascularize the flap. In the present case, a free musculocutaneous anterolateral thigh flap to cover a large-sized and deep lumbosacral defect was used. Arterial anastomosis was performed, connecting the cutaneous anterolateral thigh (ALT) perforator to the perforator of the second lumbar artery. In this fashion, the arterial circulation through the flap was flowing reversely through the muscle. The concomitant vein of the descending branch of the lateral circumflex femoral artery was hooked up to the thoracodorsal vein using a long interposition vein graft because the perforator of the second lumbar vein was too small. Postoperative healing was uneventful. In conclusion, a successful reconstruction of a lumbar defect has shown that local perforators in the lumbar area may be accessible for easier perforator-to-perforator anastomoses and that the muscular part of the musculocutaneous ALT flap can survive on retrograde arterial perfusion from a perforator of the skin island.
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ABSTRACT: The anterolateral thigh (ALT) perforator flap has become one of the major workhorses in reconstructive surgery because of its reliability and low donor site morbidity. However, the indications for this flap are limited when underlying cavities need to be filled or a separate bulk of muscular tissue is needed. To overcome these setbacks, an adipocutaneous-muscle ALT chimera flap with a muscular appendage supplied by a separate branchlet of the perforator pedicle is a useful tool. This work describes the surgical procedure and shows the results of 15 patients with a chimera ALT flap in a series of 88 patients with ALT flaps. Patients with defects after trauma (n = 8), cavities after tumour resection (n = 5) or patients with fasciitis (n = 2) were considered for an ALT chimera flap. A separate vessel for the muscular appendage was found in all 15 cases and the chimera flap could be raised successfully. Filling the underlying cavities and smooth cutaneous defect coverage was possible in all cases. No flap failure was seen (failure rate 5.6% in the whole series), but two patients required microsurgical revisions. Other complications were similar to regular ALT flap procedures. Only one patient developed a complication possibly related to including the muscular component (donor site haematoma). A separate muscular appendage added to the classical ALT flap allows an expansion of the indications of a flap well known for its low complication rate and versatility in reconstructive surgery. KeywordsChimera flap-Microsurgery-ALTP-PerforatorEuropean Journal of Plastic Surgery 04/2012; 33(2):75-78.