Outcomes of anterolateral thigh free flap thinning using liposuction following lower limb trauma

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 65; no. 4; pp. 474 - 481
• Main Authors: Askouni, Evita Paraskevi, Topping, Adam, Ball, Simon, Hettiaratchy, Shehan, Nanchahal, Jagdeep, Jain, Abhilash
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.04.2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; ALT flap; Anterolateral thigh flap; Biological and medical sciences; Female; Flap thinning; Fractures, Bone - surgery; Free Tissue Flaps; Humans; Leg Injuries - surgery; Lipectomy - methods; Liposuction; Male; Medical sciences; Middle Aged; Plastic Surgery; Postoperative Period; Reconstructive Surgical Procedures - methods; Skin plastic surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surveys and Questionnaires; Thigh; Tibial Fractures - surgery; Treatment Outcome; ALT flap; Flap thinning; Anterolateral thigh flap; Liposuction; Prognosis; Treatment; Thinning; Surgery; Thigh; Free flap; Lower limb; Trauma
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2011.11.007

Summary Background Whilst soft tissue closure is the priority to prevent infection in open fractures of the lower limb, some patients find that bulky flaps interfere with function and dislike the appearance. We report the outcomes of delayed free anterolateral thigh flap thinning with liposuction. Material and methods 38 patients treated between 2006 and 2009 were offered flap contouring. 23 chose flap thinning and 15 did not. We measured outcomes using the SF-36v2 questionnaire and cosmetic outcome scores pre and postoperatively at a mean follow up of 12 weeks (range 10–16 weeks). Results SF-36v2 physical health (PH) scores improved from a mean of 67 preoperatively to 80 postoperatively ( p  = 0.01) in the thinned group, while mental health (MH) scores remained unchanged (74–72). The mean SF-36v2 scores for the non-thinned group were 77 (PH) and 86 (MH). Following liposuction the median cosmetic outcome scores out of 5 improved from 1 (not at all satisfied) to 4 (very satisfied) postoperatively ( p  = 0.0005), which was also higher than the non-thinned group (3) [moderately satisfied], p  = 0.004). There was no difference in sex, age, BMI and region on the leg of free flap reconstruction between the non-thinned and thinned groups. Conclusions Delayed contouring of free ALT flaps used for lower limb reconstruction results in improvements in physical health measures and cosmetic outcomes. Patients not requesting thinning are generally satisfied with their reconstruction.