A Retrospective Cohort Study of the Anterolateral Thigh Flap in Lower Extremity Traumatic Reconstruction. Does the Muscle Matter?

Background

Anterolateral thigh (ALT) flaps has served as a workhorse in lower extremity reconstruction. Flap design showcases both fasciocutaneous (ALT-FC) and myocutaneous variants; the latter includes variable amounts of vastus lateralis muscle (ALT-VL). This study aims to evaluate outcomes of ALT flaps for lower extremity reconstruction at a Level 1 trauma center between ALT-FC and ALT-VL variants and assess if there is any added benefit of muscle in flap design.

Methods

A retrospective review was conducted at Los Angeles General Medical Center (2007–2022). Demographics, medical comorbidities, injury characteristics, and outcomes were collected. Outcomes included flap necrosis, postoperative infection, and ambulatory function.

Results

Among 413 flaps placed, 63 were ALT flaps, of which 43 (68.3 %) were ALT-FC and 20 (31.7 %) were ALT-VL. Patient comorbidities, defect size, and wound severity were not significantly different across cohorts. Infectious and flap outcomes were comparable between cohorts, yet significantly more patients with hypertension and diabetes mellitus had osteomyelitis overall and in the ALT-FC cohort; patients with diabetes mellitus had significantly more flap complications. Flap survival was 96.8 % with 58.7 % of patients being fully ambulatory, without significance across degrees of ambulation or time to full ambulation.

Conclusions

Our findings demonstrated good outcomes with low rates of infection and flap loss that were comparable between both ALT-FC and ALT-VL cohorts. ALT-FC has recently been favored given decreased donor site morbidity without impaired function or infectious/flap complications. Accordingly, our findings may suggest that the addition of muscle to flap design may not be necessary for successful reconstruction.