Anterolateral thigh free flap

Considerations

Preparation

Procedure

• • Mark the axis of the surface of the septum between the rectus femoris and the vastus lateralis is with a line connecting the anterior superior iliac spine and the lateral patella

    • Divide this line into thirds for purposes of outlining the flap

  • Doppler and mark the perforators

  • Design the flap, including 

    • The junction of the proximal and middle third

      • Often the site of a perforator that pierces the tensor fascia lata, which may be critical if the distal perforators are of poor quality or injured

    • The junction of the middle and distal third is marked and is also incorporated into the flap

  • Incise anteriorly

  • Elevate the anterior flap toward the septum 

    • Preserve perforators through the rectus femoris 

  • Incise posteriorly 

  • Elevate the posterior flap

    • Preserve perforators through the vastus lateralis 

    • Dissect the inferior perforator toward the descending branch of the lateral circumflex femoral artery 

  • Identify the septum and septal perforators 

  • Determine the vital perforators 

    • If the perforators are trans-septal, identify the descending branch of the LCFA between the RF and VL muscles and dissect proximally 

    • If the perforators are trans-muscular, dissect through muscle to the descending branch of the LCFA and dissect proximally 

  • Dissect the pedicle proximally

  • Harvest the flap

  • Closure

    • Raise subcutaneous flaps medially and laterally superficial to the fascia

    • Place a JP drain

    • Approximate with deep buried interrupted 3-0 Polysorb

    • Approximate the skin

    • Dressing 

Sample operative report

Post-op

Pearls & Pitfalls

High-Yield

Links

• YouTube (13:42) - ALT Anterolateral Thigh Flap HD

• eMedicine - Lateral Thigh and Anterolateral Thigh Free Tissue Transfer

• Microsurgeon.org - The Anterolateral thigh (ALT) flap

• UTMB grand rounds - ALT flap