What is an ALT flap?

The ALT flap is a very common, workhorse, flap used for various soft tissue reconstructionl. ALT stands for AnteroLateral Thigh flap. It is a skin flap that is harvested from the lateral thigh with the main blood vessels coming from the Deep Femoral Artery with a branch called the Lateral Circumflex Vessels.

Treatment of Chronic Wounds & Wound Care

There are many thousands of patients in the community with chronic wounds. The definition of a chronic wound is one that has not healed by six weeks time. As most of us know, wounds of all types eventually do close within a span of six weeks. This can range from small cuts and abrasions to larger open wounds of the legs or the abdomen from trauma or surgery. There are many patients in the community who have been undergoing local wound care for many months to years with minimal to no results. These wounds can degenerate into deeper infection such as osteomyelitis-- deep bone infection, and future loss of the limb.

Local wound care is very important to healing a wound. There have been many technological advances in newer dressings that have made wound care safer and more effective for the patient and health care provider. When a wound and has stopped healing in the six-week timespan, it is important to stop and reassess the wound. More than likely there are other causative factors that are preventing the wound from healing. This is when it is time to seek consultation from wound care experts.

As reconstructive plastic surgeons, we are the premier wound care experts. We have the ability to not only asses the wound, but have every option available to us to treat the wound. We are surgeons who deal with three dimensional anatomy. What this means is that we can assess the wound from a top-down and bottom-up approach that accounts for every part of the wound anatomy. Not all health professionals in wound care can have this approach as they cannot take the patient to the operating room to fully explore the wound and it cleanse the wound via débridement. The the ability to explore and debride a wound is the most critical factor in healing a chronic wound.

The options available to plastic surgeons include local wound care, negative-pressure (VAC, EZCare Negative Pressure, etc), to high-tech dressings such as Actcoat, Apligraf, Dermagraft, Integra, etc. After this we have the ability to place skin grafts that are split-thickness or full-thickness. We also have the ability to perform a local flaps which allow us to move tissue into the local area to close the wound. Finally, a plastic surgeon has the ultimate tool in reconstructive surgery--Microsurgery. We are able to transplant live tissue from another part of the body to the wound that requires this new tissue. We are able to reconnect the blood vessels to the transplanted tissues to close wounds that were never thought possible. Specifically, wounds that have been radiated or are chronically infected for many years have very few options for treatment. With microsurgical free tissue transfer, we have all of the options available in the reconstructive ladder to heal any wound, of any type, and size.

I encourage those who have been living with difficult wounds in their life to seek consultation with us to see if there are better options than the status quo of a nonhealing chronic wound.

Treatment of Osteomyelitis in the Extremity

Osteomyelitis is a severe and devastating bone infection. This can occur from simple wounds (venous stasis ulcers) to severe trauma of the extremity from open fractures.

In our practice, we find that many patients have not been adequately treated for osteomyelitis. In our view, osteomyelitis is a surgical disease. This means that IV antibiotics and other lesser therapies (such as hyperbaric oxygen) have only a minor role in the true treatment of this disease. The only sure way to eradicate osteomyelitis is to debride all necrotic and infected tissue, including the bone. The reason why this is not always done is because of the concern for removing bone , and soft tissue, which is not always replaceable.

At the PROS Center, we worked hand in hand with our orthopedic colleagues to have an OrthoPlastic approach to osteomyelitis. This means that we have our orthopedic surgeons, as the bone specialists, to remove all of infected bone. As plastic surgeons, we then have the expertise to provide all of the options for stable soft tissue coverage. Once the soft tissue envelope is stabilized, the orthopedic surgeons may return to perform other ancillary procedures to replace or stabilize the bone.

There are a few centers in the country, where there can be one-stop shopping to treat these extremely complex disorders such as osteomyelitis.