Anterolateral Thigh Flap for the Reconstruction of Head and Neck Defects

Abstract

This paper presents our clinical experience with head and neck reconstruction using radial forearm flap and our preliminary experience with anterolateral thigh (ALT) flap. We analyze the advantages and disadvantages of these 2 flaps from the complications we have encountered. From 1993 to 2006, the radial forearm flap has been used in 75 patients, whereas we began using the ALT flap in 2006. Since this time, we have used the ALT flap in 10 patients. One flap partial loss was observed in a patient who underwent reconstruction of the ethmoid region and nasal bones with an osteofasciocutaneous radial flap. In one patient who underwent reconstruction with ALT flap, inadequate venous outflow was discovered, and the flap was salvaged with reexploration, removing of the cutaneous component of the flap and using antithrombotic agents. Donor-site complications were experienced in 8 of 75 patients who underwent reconstruction with radial forearm flap, whereas all donor thighs healed uneventfully. Anterolateral thigh flap gives optimal results either at the donor site or at the accepting site, being easy to harvest and providing an ideal reconstructive option. Nevertheless, radial forearm flap remains a valuable alternative in case of a thin soft tissue reconstruction because of its thinness and versatility; furthermore, it can provide a long and constant pedicle of large caliber. However, since we began using the ALT flap, we had only performed this flap with respect to radial forearm flap because of its lower donor-site morbidity.

The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: One surgeon's experience in 92 cases

“…Several discussions exist in the literature about replacing the RFFF with the ALT flap. 23 We use the RFFF only for the smallest oral cavity defects, and only when extreme pliability and thinning are critical for the patient's functional outcome (e.g., for small defects of the cheek, floor of the mouth, or soft palate), preferring it to a perforator ALT flap; for all other defects, the free ALT musculocutaneous flap is used.…”

A systematic review of anterolateral thigh flap donor site morbidity

“…T he anterolateral thigh (ALT) flap, first described as a septocutaneous perforator-based flap by Song et al (1) in 1984, has recently gained popularity and has become an important option for reconstruction of multiple anatomical locations such as the head and neck (3)(4)(5)(6)(7)9,10,(12)(13)(14)16,(18)(19)(20)(21)(22)(23)(25)(26)(27)(28)(29)(30)32,34,36,38,39,(41)(42)(43), upper (15)(16)(17)(18)(19)26,32,35,37,38,42) and lower (8,(16)(17)(18)(19)22,24,…”

Maxillary reconstruction using anterolateral thigh flap and bone grafts

“…Donor site morbidity is typically less than with the rectus abdominis free flap, without a risk for abdominal hernia. The use of ALT flap has been widely described in literature and today is worldwide considered as the first choice for several kind of defects reconstruction: RodriguezVegas et al 17 reported its use without bone grafts in reconstruction of complex orbitomaxillary defects supporting the flap reliability for such reconstructions; Agostini et al, 18 Valentini et al, 19 and Chen et al 20 confirmed the ALT application in oral cavity reconstruction, underlining the versatility of the flap for the restoration of the internal oral lining. Other authors, such as Malata et al 21 and Amin et al, 22 reported their experience with ALT flap for skull base and craniofacial defects reconstruction, focusing on the large amount of well revascularized tissue provided used for the filling of the death spaces, the low rate of complications and the stability of the results obtained.…”