Clinical Results of Anterolateral Thigh Perforator Flap for Soft Tissue Reconstruction of the Foot and Ankle

Soo-Hong Han; In Tae Hong; Yohan Lee; Yong-Gil Jo; Young Woo Kwon

doi:10.4055/jkoa.2017.52.1.40

Journal List > J Korean Orthop Assoc > v.52(1) > 1013545

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Han, Hong, Lee, Jo, and Kwon: Clinical Results of Anterolateral Thigh Perforator Flap for Soft Tissue Reconstruction of the Foot and Ankle

Original Article

Journal of the Korean Orthopaedic Association 2017; 52(1): 40-48.

Published online: 16 February 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.1.40

Clinical Results of Anterolateral Thigh Perforator Flap for Soft Tissue Reconstruction of the Foot and Ankle

Soo-Hong Han, M.D., In Tae Hong, M.D., Yohan Lee, M.D., Yong-Gil Jo, M.D., Young Woo Kwon, M.D.

Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Correspondence to: Soo-Hong Han, M.D. Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. TEL: +82-31-780-5270, FAX: +82-31-780-5944, hsoohong@daum.net

Received 2 February 2016 Revised 9 March 2016 Accepted 16 July 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Soft tissue reconstruction of a defect around the foot and ankle is a particularly challenging procedure due to the anatomical and functional characteristics of this area. Hence, only a limited number of treatment options are available. Moreover, if patients wish to avoid additional scars on the ipsilateral lower leg for cosmetic reasons, even fewer options are available for treatment. The authors used an anterolateral thigh perforator flap for soft tissue defects in this area, when other surgical options were inadequate. The aim of this study was to report the clinical results and the efficacy of this procedure.

Materials and Methods

Sixteen cases of soft tissue defects around the foot and ankle were included. Participants included 12 male and 4 female subjects, and the mean age was 34 years. The most common cause of defect was acute trauma, and the average follow-up period was 33 months. Flap survival time, surgical complications, and ambulation status at the final follow-up stage were evaluated.

Results

All 16 flaps successfully survived, except for one case with partial flap necrosis that was thought to be due to weight bearing earlier than scheduled. All patients were able to walk independently without any aid at the final follow-up stage. No patients showed other significant surgical complications.

Conclusion

The anterolateral thigh perforator flap is a good alternative for soft tissue defects of the foot and ankle, when other options are not applicable. This study also demonstrated that surgery using an anterolateral thigh perforator flap is safe and highly reliable.

Keywords: foot, ankle, soft tissue injuries, reconstructive surgical procedures, perforator flap

Figures and Tables

Figure 1

(A) The flap size was designed to be 16×19 cm in an elliptical shape. (B) The flap was dissected from the donor site. The descending branch of the lateral circumflex femoral artery and perforator artery was seen between the flap and the donor site. (C) The flap was detached from the donor site. The perforator artery was seen on the bottom of flap attachment. (D, E) The end-to-end anastomosis of 2 veins and 1 artery was done between the recipient site and the flap. (F) Splitthickness skin graft was done on the donor site.

Figure 2

(A) A 8×5 cm sized soft tissue defect on the anterior ankle. (B) Anterolateral thigh flap application. (C, D) Twenty months after the anterolateral thigh flap surgery with fully recovered range of motion.

Figure 3

(A) Scar contracture on the dorsum of the left foot. (B, C) Seven months after the anterolateral thigh flap surgery.

Figure 4

(A) Chronic inflammatory reaction with superficial necrosis on the posterior ankle. (B) Debridement of necrotic tissue. A 15×7 cm sized anterolateral thigh flap (C), 12 months after the surgery (D).

Table 1

Patient Characteristics and Results

DM, diabetes mellitus; STSG, split thickness skin graft.

Table 2

Scoring System to Evaluate the Recipient Site of the Foot and Ankle

Result: cosmetic+functional (×2)+sensory+wound+pain (excellent, 0–5; good, 6–10; fair, 11–15; poor, 16–20). LROM, limited range of motion.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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