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. 2012 Spring;20(1):17-23.
doi: 10.1177/229255031202000103.

A systematic review of anterolateral thigh flap donor site morbidity

Jessica Collins  1 , Olubimpe Ayeni, Achilleas Thoma
Affiliations

A systematic review of anterolateral thigh flap donor site morbidity

Jessica Collins et al. Can J Plast Surg. 2012 Spring.

Abstract
in English, French

Purpose: The anterolateral thigh (ALT) flap is widely used in reconstruction. Its advantage over other flaps is its purported minimal donor site morbidity. The present systematic review summarizes the types of complications and their incidence with this flap. A secondary objective is to delineate factors that influence these complications and make recommendations to avoid them.

Method: Two independent assessors undertook a systematic review of the literature using multiple databases. All patients with ALT flap reconstruction for any defect were included. Donor site complications including lateral thigh paresthesia, musculoskeletal dysfunction, hypertrophic scarring, wound breakdown, infection, donor site pain, seroma, hematoma, compartment syndrome and muscle necrosis were extracted from identified articles and tabulated. Based on the number of pooled events and the number of cases performed, an incidence rate was calculated.

Results: Forty-two relevant articles were identified that included 2324 flaps. Of the 2324 flaps, the majority were fasciocutaneous (n=737), and 1303 of the flaps were used in head and neck reconstruction. The incidence of complications were: lateral thigh paresthesia (24.0%); musculoskeletal dysfunction (4.8%); hypertrophic scarring or wound dehiscence (4.8%); donor site pain (3.3%); seroma (2.4%); infection (2.2%); hematoma (0.7%); compartment syndrome (0.09%); and partial muscle necrosis (0.09%).

Conclusion: Lateral thigh paresthesia is the most common complication. Severe complications such as compartment syndrome and muscle necrosis can occur, but are rare. Preservation of the lateral cutaneous nerve of the thigh, femoral motor nerve branches and deep fascia decreases the risk of complications. The degree of vastus lateralis disruption did not show a significant impact on musculoskeletal dysfunction.

Objectif: Le lambeau de la partie antérolatérale de la cuisse (PALC) est largement utilisé en reconstruction. Par rapport aux autres lambeaux, il a l’avantage de s’associer à une morbidité minimale présumée au foyer du donneur. La présente analyse systématique contient un résumé des types de complications et de leur incidence à l’égard de ce lambeau. Un objectif secondaire consiste à déterminer les facteurs qui influent sur ces complications et à présenter des recommandations pour les éviter.

Méthodologie: Deux évaluateurs indépendants ont procédé à une analyse systématique des publications à l’aide de multiples bases de données. Tous les patients ayant subi une reconstruction par lambeau de la PALC pour corriger une anomalie y ont participé. Dans les articles retenus, les évaluateurs ont extrait les complications au foyer du donneur et en ont fait des tableaux, y compris une paresthésie de la cuisse latérale, une dysfonction musculosquelettique, une cicatrice hypertrophique, une dégradation de la plaie, une infection, une douleur au foyer du donneur, un sérome, un hématome, un syndrome des loges et une nécrose musculaire. D’après le nombre d’événements regroupés et de cas exécutés, ils ont calculé un taux d’incidence.

Résultats: Les évaluateurs ont repéré 42 articles pertinents, qui incluaient 2 324 lambeaux, dont la majorité était d’origine fasciocutanée (n=737), 1 303 ayant été utilisés pour une reconstruction de la tête et du cou. L’incidence de complications s’établissait comme suit : paresthésie de la cuisse latérale (24,0 %), dysfonction musculosquelettique (4,8 %), cicatrice hypertrophique ou déhiscence de la plaie (4,8 %); douleur au foyer du donneur (3,3 %), sérome (2,4 %), infection (2,2 %), hématome (0,7 %), syndrome des loges (0,09 %) et nécrose musculaire partielle (0,09 %).

Conclusion: La paresthésie latérale de la cuisse est la complication la plus courante. De graves complications, telles qu’un syndrome des loges et une nécrose musculaire, se produisent, mais rarement. La préservation du nerf cutané latéral de la cuisse, des branches nerveuses du fémur et du fascia lata réduisent le risque de complications. Le degré de perturbation du muscle vaste externe n’avait pas de répercussions importantes sur la dysfonction musculosquelettique.

Keywords: Anterolateral thigh flap; Complications; Donor site.

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Figures

Figure 1)
Figure 1)
Tissue composition of anterolateral thigh flaps: Percentage of flaps elevated as cutaneous, fasciocutaneous, or musculocutaneous flaps and the number of cases in which the type of flap was not reported or unclear
Figure 2)
Figure 2)
Indications for anterolateral thigh flap reconstruction: Percentages of flaps used to reconstruct defects of the head and neck, upper extremity, lower extremity and trunk (including chest, thorax abdomen, back, perineum, genitourinary) regions, as well as the cases in which the indication was not reported
Figure 3)
Figure 3)
Per cent incidence of patients (y-axis) with complications associated with the anterolateral thigh flap donor site (x-axis)
See this image and copyright information in PMC

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