ABSTRACT: Anterolateral Thigh Flap for Postmastectomy Breast Reconstruction
Most postmastectomy defects are reconstructed by use of lower
abdominal-wall tissue either as a pedicled or free flap.
there are some contraindications for using lower abdominal flaps
in breast reconstruction, such as inadequate soft-tissue volume,
previous abdominoplasty, lower paramedian or multiple abdominal
scars, and plans for future pregnancy.
In such situations, a
gluteal flap has often been the second choice.
However, the quality
of the adipose tissue of gluteal flaps is inferior to that of
lower abdominal flaps, the pedicle is short, and a two-team
approach is not possible because creation of the gluteal flap
requires that the patient's position be changed during the operation.
In 2000, five cases of breast reconstructions were performed with
anterolateral thigh flaps in the authors. institution.
Two of them
were secondary and three were immediate unilateral breast
reconstructions. The mean weight of the specimen removed was
350 g in the three patients who underwent immediate reconstruction,
and the mean weight of the entire anterolateral thigh flap was
410 g. Skin islands ranged in size from 4 x 8 cm to 7 x 22 cm,
with the underlying fat pad ranging in size from 10 x 12 cm to
14 x 22 cm. The mean pedicle length was 11 cm (range, 7 to 15 cm).
All flaps were completely successful, except for one that involved
some fat necrosis.
The quality of the skin and underlying fat and the pliability of
the anterolateral thigh flap are much superior to those of gluteal
flaps and are similar to those of lower abdominal flaps.
patients, more subcutaneous fat can be harvested by extending the
flap under the skin. Use of a thigh flap allows a two-team approach
with the patient in a supine position, and no change of patient
position is required during the operation.
However, the position
of the scar may not be acceptable to some patients.
Therefore, when an abdominal flap is unavailable or contraindicated,
the creation of an anterolateral thigh flap for primary and secondary
breast reconstruction is an alternative to the use of lower abdominal
and gluteal tissues.
[07/11/2002; Plastic and Reconstructive Surgery]
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