More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap.

Abstract

For obliterating a dead space, especially deep and slender, it is more challenging for a reconstructive surgeon to design a musculocutaneous flap by conventional technique. Tethering at the midway of a musculocutaneous flap while inset is not unusual, and trimming of excess muscle may jeopardize the perfusion of the skin. Based on the lateral femoral circumflex system (LFCS), introducing a chimeric concept into the reconstruction of these difficult wounds will simplify the flap design and give more degrees of freedom to inset the flap. Technique of intramuscular dissection of perforators is frequently demanded. Vastus lateralis muscle based on the distal runoff of the LFCS can be included with sharp dissection. Using chimeric concept in the application of anterolateral thigh flap, the muscle and skin can be considered as individual units although they base on a single pedicle. The dimension of skin and the volume of muscle can be tailored as adequate as desired. While insetting the flap, the lengthy pedicles distal to the bifurcation enhance a three-dimensional reconstruction without difficulty. Chimeric concept of anterolateral thigh flap affords more degrees of freedom for difficult reconstructions.