Clinic Study Of Using Free Anterolateral Thigh Adipofascial Flap For Reconstruction Of Facial Depression

The anterolateral thigh flap has been used over 20 years since itwas first introduced. Anterolateral thigh flap is a fasciocutaneous flapin the anterolateral thigh region, it is named anterolateral thighadipofascial flap without the cutaneous layer, and the blood supply ofthem comes from the septocutaneous or musculocutaneous perforatorsderived from the lateral circumflex femoral vascular system. The anatomyvariations of the vascular system include the perforators' type, caliber,number, location, and the vessels the perforators derived from. Thevariable anatomy of the vascular system and the relatively difficultdissection technique are the main reason giving limitations to itspopularity.With progress has been made in the study of the flap, it was soonbeen developed for wide clinical applications. The flap can be used incombination with different tissues to form various kinds of flaps for itsclinical applications. The anterolateral thigh adipofascial flap has beenused for reconstruction of the soft tissue defects of face depression orasymmetric facial deformity, mammary augmentation, reconstruction ofextremity defects, repair of tongue defects. The anterolateral thighflaps have the advantages of large flap area, moderate thickness,possessing long and large-caliber pedicle vessels, little donor sitecomplications and malformation.This research investigated the use of free anterolateral thighadipofascial flap for soft tissue defects correction of facial depressionin 32 patients from 1996.10～2007.1. There were 33 free anterolateral thigh adipofascial flaps used in 32 patients. 31 patients' defects werein one side, 1 patient's defects were in both sides. The patients agedfrom 18～45 years old, 10 mate and 22 female patients. Among them, 23patients were diagnosed hemifaciat atrophy, 4 patients were diagnosedcraniofaciat microsomia, 3 patients' defects were caused by early traumawitch interfered the development of the face and resulted in facedepression, and 2 patients' defects were caused by tumor ablation in theface and resulted in face depression. The width of the flaps ranged from8cm～11cm, length ranged from 12cm～20cm, the area of the flaps rangedfrom 12cm×8cm～20cm×11cm. All the cases were followed uppostoperatively from 6 months to. 2. Syears. The survival rate, aestheticappearance, donor site complications and morbidities were observed andassessed postoperatively. Results: There were 33 free anterolateral thighadipofascial flaps used in 32 patients. 30 flaps survived completely, 3flaps survived with obvious absorption and received free derma fattransplantation and autologous fat injection 6 months after operation.9 patients received liposuction of the flaps 6 months postoperativelybecause of the bulky appearance, 3 of them received facial slingsimultaneously because of sagging. 33 donor sites where dissected theadipofascial flaps were performed primary skin closure and resulted inprimary healing. No obvious complications and malformation were found inthe donor sites. Conclusion: To use free anterolaterat thigh adipofascialflap for reconstruction of soft tissue defects of facial depressiondeformity can achieve relatively excellent results as it possesses theadvantages of large flap area, possessing long and large-caliber pediclevessels, easy for anastomosis, high survival rate, satisfactory results,easily concealed donor site, no need to sacrifice neither major nervesnor major blood vessels, and little donor site complications andmalformation. Although the anatomy variations of its vascular system make the operation more challenging, familiarity to the anatomy and subtleoperation technique can ensure success. So, free anterolateral thighadipofascial flap transplantation is relatively an ideal measure for softtissue defects correction of facial depression deformity.