Sarcoma Reconstruction

The anterolateral thigh flap (ALT) is an extremely versatile flap. The lateral thigh can be utilized to bring an island of tissue that is approximately 8cm X 24cm. This amount of tissue removal can be closed with one incision. Depending on the size of the area to be covered by the flap it may be necessary to harvest more tissue from the thigh. If this is the case a skin graft will be utilized to close the resulting defect on the thigh. I personally have used ALT flaps up to 35/25cm to cover large wounds of the chest and back. Normally I utilize the ALT flap for coverage of the arm and leg. It is very useful for the foot. There are multiple ways to reestablish the blood supply to the transferred tissue but usually the posterior tibial blood vessels are used. Microsurgery is used to reestablish blood flow to the tissues. This is normally done by a plastic surgeon who has had additional training in microsurgery. Typically these procedure are performed in microsurgery units or facilities where microvascular surgery is performed on a routine basis. I typically perform, ALT flap, Latissimus flaps, gracilis flaps, DIEP flaps, and freestyle free flaps depending on the needs of the patient after Sarcoma tumor removal, trauma, or infection. One of the additional points regarding ALT flaps is that they can be easily modified after surgery. Through thinning of the fat and advancement of the flap a very thin pliable flap can be created which can be then almost indistinguishable in clothing from normal tissue. Obviously externally there is a scar around the transferred tissue. I believe this is an ideal flap for multiple reconstructive challenges.