The Clinical Course of Reverse-flow Anterolateral Thigh Flap: Need to Prepare for Venous Congestion and Salvage Operation

ImageS gested reverse-flow anterolateral thigh flap and the clinical course of this flap with a literature review. A 54-year-old male patient presented with a mass of 7×6 cm on the left knee. Biopsy of the lesion revealed a myxofibrosarcoma. The distant metastasis was not detected in preoperative evaluation. After wide excision of the malignancy, a soft tissue defect with a dimension of 8×8 cm over the left knee was noted (Fig. 1). We planned for the reconstruction the composite defect using a distally based anterolateral thigh island flap. The perforators were detected with a hand held Doppler probe preoperatively. The anterolateral thigh island flap including a musculocutaneous perforator was elevated and the descending branch of the lateral circumflex femoral vessel was dissected distally. The descending branch contained two venae comitantes. Two valve areas were observed at the pedicle between the flap and the descending branch. We clamped the pedicle proximally to assess the retrograde flow into the flap. After observation for the flap circulation, the pedicle was ligated proximally. Venous engorgement was detected at the area proximal to the venous valve before the flap insetting. The pedicle measured 16 cm in length, with the pivot point located 7 cm above the patella. A splitthickness skin graft was performed to the closure of the donor-site without any tension. The refilling of the flap was relatively rapid immediately postoperatively; however, the venous congestion was not significant. Venous congestion of the flap developed slowly postoperatively at 10 hours, and worsened at 15 hours, threatening the survival of the flap; a reoperaThe Clinical Course of Reverse-flow Anterolateral Thigh Flap: Need to Prepare for Venous Congestion and Salvage Operation