Clinical applications of the pedicled anterolateral thigh flap in complex abdominal-pelvic reconstruction

Background: The free anterolateral thigh (ALT) flap has become a reconstructive workhorse with great versatility throughout the body. However, the utility of the pedicled ALT flap is less described for complex defects. A skin paddle with reliable blood circulation and wide range of reach, low donor site morbidity along with the avoidance of many of the complications plaguing free flaps, are just some of the several benefits offered by the pedicled ALT flap. We investigated specific clinical examples within our ALT flap database where the pedicled ALT flap was used for coverage of complex wounds and highlight its advantages. Methods: We conducted a retrospective chart review on those patients in whom a pedicled ALT flap was used for complex wound reconstruction over a 7-year period between July 2002 and October 2009 at The R Adams Cowley Shock Trauma Center performed by a single surgeon. Results: Four patients underwent a pedicled ALT flap as part of their reconstruction. Flaps ranged in size from 75 to 648 cm, and all but one were cutaneous in nature with the other one being fasciocutaneous. The flaps averaged 2 perforators (range, 1-3) and the donor sites were all closed primarily except for one. ConclusionS: When faced with a complex defect in the abdominal-pelvic region, we propose that the pedicled ALT flap has several advantages to other types of tissue coverage and is an excellent option for the reconstructive surgeon.