The usefulness of microsurgical pedicle lengthening in free anterolateral thigh flaps

Background: A microsurgical pedicle-lengthening technique can be used when a pedicle length longer than that usually provided by an anterolateral thigh (ALT) flap is required. The purpose of this report is description of pedicle lengthening method from original pedicle length for free ALT flaps and presentation of the results of application of this technique in reconstruction from a series of cases. Patients and Methods: The microsurgical pedicle-lengthening procedure was used in 10 patients who received free ALT flaps from January 2012 to June 2015. The location of reconstruction was the heel in 3 patients, foot in 3 patients, flank in 2 patients, forehead in 1 patient, and lower leg in 1 patient. The technique was categorized as two distinct 2 types according to the branching pattern of the perforator. The transected segments of the extra vessel lengths were translocated anterogradely, and used to perform pedicle extensions. Results: The average length of the original pedicle was 13.1 cm (range 10.1–16.4 cm), and the average gain in length using the pedicle-lengthening method was 6.5 cm (range 5.0–8.1 cm). All the flaps survived well postoperatively. Of the 10 patients, three experienced complications that included partial flap necrosis in one patient, wound dehiscence in one patient, and seroma in the third patient. No major complications occurred. Conclusion: The microsurgical pedicle-lengthening technique described here offers a solution for pedicles that are shorter than expected, with additional surgery required. This method may help overcome emergency situations that can arise during ALT flap surgery.