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Thin-ALT and SCIP flaps versus standard ALT for lower extremity reconstruction: how thick is the evidence?

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The anterolateral thigh (ALT) free flap is commonly used for complex lower limb reconstruction. Recently, other thin perforator flaps—such as the thin-ALT flap and the superficial circumflex iliac artery perforator (SCIP) flap—have become increasingly utilized in this indication. There is limited evidence examining the performance of these thin suprafascial flaps to the standard ALT flap. We aim to systematically review the literature, assessing the survival and complication rates of the standard ALT, thin-ALT, and SCIP flaps in lower limb reconstruction.

Methods

Following PRISMA guidelines, we systematically searched BIOSIS®, PubMed®, Cochrane Library®, Embase®, MEDLINE®, and Web of Science® on Jan. 27, 2021. Only primary English studies published in peer-reviewed scientific journals and that explored lower limb reconstruction were included.

Results

We included 68 studies, comprising 1652 standard ALT, 187 thin-ALT, and 129 SCIP flaps. Thin-ALT flaps demonstrated significantly lower rates of full flap failure (0.6%, N = 1/187) compared to standard ALT flaps (3.9%, N = 64/1652). Thin-ALT and SCIP flaps have been more frequently used in foot reconstruction (47.6%, N = 50/105; 82.9%, N = 29/35 respectively), whereas standard ALT flaps have been more frequently used in leg (43.0%, N = 182/423) and trauma-related reconstructions (84.3%, N = 334/396). Thin-ALT and SCIP flaps have a smaller mean surface area, as well as significantly lower rates of thinning (6.2%, N = 5/80; 4.5%, N = 5/112, respectively) compared to standard ALT flaps (26.1%, N = 43/165).

Conclusions

Thin-ALT and SCIP flaps demonstrate low rates of flap failure and secondary complications that are comparable to standard ALT flaps. Thin-ALT and SCIP flaps are viable options for complex lower extremity reconstruction.

Level of evidence: Not gradable

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Data availability

All of the data analyzed in this review are publicly available and are cited below.

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Authors and Affiliations

  1. Schulich School of Medicine, Western University, London, ON, Canada

    Valera Castanov, Erica A. Li, Kaveh Farrohki, Kathryn Minkhorst, Khalifa AlGhanim & Andrew M. Simpson

  2. Division of Plastic and Reconstructive Surgery, Western University, London, ON, Canada

    Valera Castanov, Kathryn Minkhorst, Khalifa AlGhanim & Andrew M. Simpson

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  1. Valera Castanov
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  2. Erica A. Li
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Correspondence to Andrew M. Simpson.

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Valera Castanov, Erica A. Li, Kaveh Farrohki, Kathryn Minkhorst, Khalifa AlGhanim, and Andrew M. Simpson declare no conflict of interest.

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Castanov, V., Li, E.A., Farrohki, K. et al. Thin-ALT and SCIP flaps versus standard ALT for lower extremity reconstruction: how thick is the evidence?. Eur J Plast Surg 46, 923–934 (2023). https://doi.org/10.1007/s00238-023-02124-7

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