1. VERSATILITY OF
ANTEROLATERAL THIGH
FREE FLAP
N. Rajacic MD
Al –Seef hospital Kuwait

3. mmmmmmmmmmm

4. FLAP SELECTION
Recipient site requirements
Availability
Familiarity
4

5. FREE FLAPS
• GROIN
TEMPORALIS FASCIA
• LATISSIMUS DORSI
• SCAPULAR AND P.SCAPULAR FLAP SERRATUS FASCIA
• RADIAL AND ULNAR FOREARM
FIBULA FLAP
• DELTOID FLAP
• LATERAL ARM ILIAC CREST
• TRAM
JEJUNAL FLAP
• TFL
• DORSALIS PEDIS OMENTAL FLAP
• … …

6. ANTEROLATERAL THIGH FLAP
SONG 1984
Fu-Chan-Wei
Koshima

7. VASCULAR ANATOMY
DESCENDING BRANCH OF LCFA
SEPTOCUTANEOUS PERFORATORS (12-32%)
MUSCULOCUTANEOUS PERFORATORS

8. Transverse branch
Nerve for m. Vastus lat.
LCFA
Descending branch
m. Vastus. lat

9. m. Rectus femoris
Descending branch LCFA
Septocutaneous branch LCFA

10. Septocutaneous branch
descending branch LCFA

11. Perforating branch
m. Vastus lateralis
Descending branch of LCFA
m. Rectus femoris

12. Musculocutaneous perforators

13. PREOPERATIVE REQUIREMENT
•NO NEED OF ANGIOGRAPHY
•DETECTION OF PERFORATOR BY DOPPLER FLOWMETER IS
ESSENTIAL

14. Spina iliaca
anterior superior
PLANING OF
THE FLAP
Patella

15. COMPOSITION
MUSCLE
MUSCLE +SKIN
FASCIOCUTANEOUS
ULTRATHIN SKIN
FLOW-THROUGH FLAP
FUNC. MUSCLE TRANSFER
VASC. NERVE GRAFT

16. MUSCLE FLAP m. Rectus femoris
TFL
m. Vastus lat.

20. MYOCUTANEOUS FLAP

26. FASCIOCUTANEOUS FLAP

27. PLANE OF DISSECTION

33. ULTRATHIN SKIN FLAP

34. THINING OF THE FLAP
0,5 cm

40. SHAPING OF THE FLAP
DEEPITHELIASATION
INNER LINING
OUTER
COVER

41. FUNCTIONAL MUSCLE TRANSFER

44. Combined flap- chimeric principle

46. FLOW-THROUGH FLAP

52. Vascularised nerve graft

58. ADVANTAGES DISADVANTAGES
• SAFE AND EASY ELEVATION • VARIABLE ANATOMY
• LONG VASCULAR PEDICLE (10-12cm) • DONOR SITE GRAFTING IN CASE OF
• LARGE CALIBER VESSEL (2mm) LARGE FLAPS ( MORE THAN 10 cm)
• LARGE DONOR FLAP AREA (30X18cm) • HAIRY SKIN IN MALES
• POSSIBILITY OF THINNING THE
FLAP
• MINIMAL DONOR SITE MORBIDITY
• POSSIBILITY OF MULTIPLE FLAPS ON
THE SAME PEDICLE (CHIMERIC
PRINCIPLE)
• NO NEED TO CHANGE POSITION OF
THE PATINET (SUPINE POSITION)

59. CONCLUSION
ANTEROLATERAL FLAP IS EXTREMELY
RELIABLE FLAP FOR THE RECONSTRUCTIONS OF
VARIOUS DEFECTS DUE TO GOOD LENGTH AND
SIZE OF PEDICLE, LARGE AMOUNT OF TISSUE OF
DESIRABLE THICKNESS AND COMPOSITION ,
EASY DISSECTION AND MINIMAL DONOR SITE
MORBIDITY