Flow-through Anterolateral Thigh Flaps: Report of 3 Consecutive Cases and Review of its Utility

• Main Authors: Noah H. Saad, MD, Kelly Rosso, MD, Howard Wang, MD, Douglas Cromack, MD, Efstathios Karamanos, MD
• Format: Article
• Language: English
• Published: Wolters Kluwer 2021-05-01
• Series: Plastic and Reconstructive Surgery, Global Open
• Online Access: http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003584

Summary. In the field of plastic and reconstructive surgery, soft tissue reconstruction of Gustilo 3B with peripheral vascular disease or 3C fractures is a complex treatment algorithm. The concomitant issue of soft tissue coverage with vascular reconstruction is the main challenge when opting for free tissue transfer. The flow-through flap offers the surgeon the ability to treat a vascular injury or high-grade stenosis to maintain distal perfusion, while also providing soft tissue coverage. In this study, we present a case series of 3 patients who underwent flow-through anterolateral thigh free flap for lower extremity soft tissue coverage. Each patient had a history of trauma and either single vessel runoff or a dominant branch with diminutive secondary blood flow to the foot. All patients successfully underwent free flap reconstruction of lower extremity wounds while concomitantly reconstructing diseased arterial supply. Only 1 patient suffered partial flap loss postoperatively that was treated with debridement and split thickness skin grafting. Flow-through free tissue transfer is a valuable treatment option not only in Gustilo 3C fractures requiring soft tissue coverage, but also in patients with Gustilo 3B fractures with peripheral vascular disease.