Free Anterolateral Thigh Flap for Reconstruction of Major Craniofacial Defects

Abstract

Free-tissue transfer has revolutionized skull-base surgery by expanding the ability to perform cranial base resection and by improving the quality of reconstruction. The anterolateral thigh flap has come recently into use in the field of head and neck reconstruction. Its role in craniofacial and midface reconstruction has not been specifically defined. This study involved a total of 18 patients who were treated over a 5-year period from 1998 to 2003. Seventeen patients had locally advanced head and neck cancer, requiring craniofacial resection, and one patient had a complicated gun shot wound of the forehead. Thirteen patients were treated at the National Cancer Institute, Cairo University, Egypt, and five patients at the University of Miami, Florida. The patients presented with defects of the anterior skull base (5), lateral skull base (3), scalp and calvarium (3), and the midface (7). The anterolateral thigh flap was used as a myocutaneous flap in 11 cases and as a perforator fasciocutaneous flap in seven cases. Musculocutaneous perforators supplied the majority of flaps (17/18). Total flap survival occurred in 17 cases; one patient developed complete flap necrosis. The most commonly used recipient vessels were the facial vessels and the external jugular vein. Major complications included one case with meningitis; the patient died after failure of treatment. Another patient died 6 weeks postoperatively from pulmonary embolism. One patient developed CSF leak that stopped spontaneously. In addition, two patients developed minor wound dehiscence that healed spontaneously. The donor-site wound healed without problems except in two cases. One patient had an incomplete take of the skin graft; the other developed wound infection and superficial sloughing. Both wounds healed spontaneously. In addition to the feasibility of simultaneous flap harvesting with tumor resection, the flap's advantage in skull base reconstruction is its reliable blood supply, which can provide adequate dural cover and protection of the brain. Its size and moderate thickness are suitable for reconstruction of scalp and calvarial defects. The abundance of reliably vascularized fat in the flap may be an advantage in long-term maintenance of the volume of the flap in midface reconstruction. Similar to other soft tissue flaps, additional skeletal reconstruction may still be required to achieve an optimal functional and aesthetic result.

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

“…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. Finally, Mureau et al 23 and Hong et al 24 presented their experience with the use of ALT flap for the external coverage reconstruction, with particular care to the donor site morbidity and the final cosmetic outcome.…”

Microsurgical Reconstruction of Maxillary Defects

“…If critical segments of bone are missing, such as the orbital rim or the anterior floor of the orbit, nonvascularized bone grafts can provide the needed support. Other flap options, depending on the amount of soft-tissue bulk required, include the lateral arm flap, anterolateral thigh flap, [57] and scapula flap.…”