Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.

The anterolateral thigh (ALT) free flap was first described in 1984 by Song et al. 1 Wei et al popularized this flap. 2 They reported 672 cases of ALT flap reconstruction with minimal failure rate (2% total and 3% partial failure). Kimata et al described the versatility of the flap in head and neck reconstruction and also noted that the donor site morbidity is minimal. 3,4 An ideal soft tissue free flap for head and neck reconstruction should have the following characteristics, versatility in design, adequate tissue, appropriate texture, minimal donor site morbidity, availability of diverse tissue types on one pedicle, potential for reinnervations, long pedicle, feasibility of a two team approach, and consistent anatomy for easy and safe flap dissection. 5-7 Except for the latter, the ALT flap has been suggested to have all the qualities. The purpose of this article is to discuss the various reconstructive indications, outcome, and morbidity of ALT flap reconstruction in head and neck. MethodsThis is a retrospective study of 194 consecutive ALT free flaps used for head and neck reconstruction in a tertiary level Keywords ► head and neck cancer ► head and neck reconstruction ► anterolateral thigh flap ► oromandibular defect ► free flaps AbstractAnterolateral thigh (ALT) free flap is a common flap with multitude of indications. The purpose of this article is to review the reconstructive indications of the flap in head and neck defects. This is a retrospective study of 194 consecutive ALT flaps. Data including patient characteristics (age, sex, comorbidities), disease characteristics (histology, T stage), and flap characteristics (size of the flap, type of closure of ALT donor site) were collected. The outcome in terms of flap success rate, surgical, and donor site morbidity were studied. A total of 194 flaps were performed in 193 patients over a period of 10 years. Mean age of the patients was 55 years (range 16-80 years). Out of the 193 patients, 91 (47.1%) patients had oromandibular defects, 52 (26.9%) had tongue defects, 15 (7.7%) had pharyngeal defects, 17 (8.8%) had skull base defects, 4 (2%) had scalp defects, and 14 (7.2%) had contour defects of the neck. The overall flap success rate was 95.8% (8 total flap loss out of 194). Hypertrophic scar was the commonest donor site problem seen in 20 (10.3%) patients. This study shows the versatility of free ALT flap in head and neck reconstruction. It is a reliable and safe. Donor site morbidity is minimal.

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