[Pedicled anterolateral thigh flap reconstruction in the region of the lower abdomen, groin, perineum, and hip].

OBJECTIVE: Soft tissue reconstruction of complex defects of the lower abdomen, groin, the perineum and the hip region present a reconstructive challenge. Besides free tissue transfer, pedicled flaps may also be utilized. Harvest of the vertical rectus abdominis flap causes a functional deficit by weakening the abdominal wall. Pedicled, perforator-based flaps minimize functional deficits by preserving muscle. INDICATIONS: Soft tissue defects with exposed vital structures, prosthetic devices or irradiated wound beds. CONTRAINDICATIONS: Previous surgery at the donor site, peripheral vascular disease at the pelvic and thigh region, previous vascular interventions at the donor site. SURGICAL TECHNIQUE: After preoperative localization of the perforators, a retrograde, intramuscular dissection of the pedicle allows sufficient length to be gained in order to transpose the flap into the defect. Tunneling of the flap beneath the rectus femoris muscle and Sartorius muscle is often required for tension-free inset. POSTOPERATIVE MANAGEMENT: Five days of bed-rest postoperatively followed by ambulation.
RESULTS: No complete flap loss was encountered in 13 cases. In 2 cases a partial tip necrosis required secondary skin grafting.