Free Anterolateral Thigh Flap for Extremity Reconstruction: Clinical Experience and Functional Assessment of Donor Site

TLDR

The vastus lateralis is the largest quadriceps compartment and primary knee extensor, so its loss could compromise knee stability. Between 1995 and 1998, 38 free anterolateral thigh flaps were performed—four cutaneous and 34 myocutaneous with a vastus lateralis cuff—followed by functional donor‑site testing at least six months later in 20 patients using a kinetic communicator. The flaps achieved a 97 % success rate, and donor‑site testing showed no significant differences in quadriceps or hamstring strength except mild concentric quadriceps weakness, indicating minimal functional impairment.

Abstract

From August of 1995 through July of 1998, 38 free anterolateral thigh flaps were transferred to reconstruct soft-tissue defects. The overall success rate was 97 percent. Among 38 anterolateral thigh flaps, four were elevated as cutaneous flaps based on the septocutaneous perforators. The other 34 were harvested as myocutaneous flaps including a cuff of vastus lateralis muscle (15 to 40 cm3), either because of bulk requirements (33 cases) or because of the absence of a septocutaneous perforator (one case). However, vastus lateralis muscle is the largest compartment of the quadriceps, which is the prime extensor of the knee. Losing a portion of the vastus lateralis muscle may affect knee stability. Objective functional assessments of the donor sites were performed at least 6 months postoperatively in 20 patients who had a cuff of vastus lateralis muscle incorporated as part of the myocutaneous flap; assessments were made using a kinetic communicator machine. The isometric power test of the ratios of quadriceps muscle at 30 and 60 degrees of flexion between donor and normal thighs revealed no significant difference (p > 0.05). The isokinetic peak torque ratio of the quadriceps and hamstring muscles, including concentric and eccentric contraction tests, showed no significant difference (p > 0.05), except the concentric contraction test of the quadriceps muscle, which revealed mild weakness of the donor thigh (p < 0.05). In summary, the functional impairment of the donor thighs was minimal after free anterolateral thigh myocutaneous flap transfer.