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. 2023 Oct 1;91(4):459-467.
doi: 10.1097/SAP.0000000000003509. Epub 2023 Feb 15.

Extensive Defect Reconstruction With Pre-expanded Anterolateral Thigh Flap: Tissue Expansion of the "Outskirts"

Mengqing Zang  1 , Miao Wang, Danying Wang, Qingyan Du, Shan Zhu, Bo Chen, Shanshan Li, Zixiang Chen, Yuanbo Liu
Affiliations

Extensive Defect Reconstruction With Pre-expanded Anterolateral Thigh Flap: Tissue Expansion of the "Outskirts"

Mengqing Zang et al. Ann Plast Surg. .

Abstract

Background: Previously reported pre-expansion techniques of the anterolateral thigh flap are mainly perforator-based. The expansion will interfere with the flap harvest if the requisite perforator is found unsuitable as a pedicle. Expansion of the peripheral territories of the flap donor site can minimize the interference from the expansion.

Methods: Forty-eight peripheral pre-expansions of the anterolateral thigh flap were retrospectively reviewed in 38 patients from 2012 to 2021. The reconstructive outcomes, including flap success, increase in flap size, donor-site closure, and complications, were assessed. In addition, subgroup analysis was performed based on the expanded territories.

Results: Rate of successful flap elevation of 100% and flap survival rate of 97.9% were achieved. One patient had total flap necrosis, which was salvaged with skin grafting. Peripheral expansion attained a mean 55.5% ± 19.6% increase in flap width. Primary donor-site closure was accomplished in 95.8% of flaps and fascial restoration in 97.9% of the donor sites. Three patients developed major expansion-related complications, which required surgical intervention. One patient had wound dehiscence in the donor site, which healed by secondary intention. Compared with other subgroups, the lateral-and-medial-side expansion provided a larger flap for reconstruction (P = 0.001).

Conclusions: If time is not of the essence, peripheral pre-expansion permits direct donor-site closure with size augment of the anterolateral thigh flap. In addition, it preserves the reliability and versatility of the anterolateral thigh flap.

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Conflict of interest statement

Conflicts of interest and sources of funding: The authors received financial support for this research from the Hospital Foundation of Plastic Surgery Hospital, Chinese Academy of Medical Sciences (YS202017).

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