Have We Found an Ideal Soft-Tissue Flap? An Experience with 672 Anterolateral Thigh Flaps

Abstract

The free anterolateral thigh flap is becoming one of the most preferred options for soft-tissue reconstruction. Between June of 1996 and August of 2000, 672 anterolateral thigh flaps were used in 660 patients at Chang Gung Memorial Hospital. Four hundred eighty-four anterolateral thigh flaps were used for head and neck region recontruction in 475 patients, 58 flaps were used for upper extremity reconstruction in 58 patients, 121 flaps were used for lower extremity reconstruction in 119 patients, and nine flaps were used for trunk reconstruction in nine patients. Of the 672 flaps used in total, a majority (439) were musculocutaneous perforator flaps. Sixty-five were septocutaneous vessel flaps. Of these 504 flaps, 350 were fasciocutaneous and 154 were cutaneous flaps. Of the remaining 168 flaps, 95 were musculocutaneous flaps, 63 were chimeric flaps, and the remaining ten were composite musculocutaneous perforator flaps with the tensor fasciae latae. Total flap failure occurred in 12 patients (1.79 percent of the flaps) and partial failure occurred in 17 patients (2.53 percent of the flaps). Of the 12 flaps that failed completely, five were reconstructed with second anterolateral thigh flaps, four with pedicled flaps, one with a free radial forearm flap, one with skin grafting, and one with primary closure. Of the 17 flaps that failed partially, three were reconstructed with anterolateral thigh flaps, one with a free radial forearm flap, five with pedicled flaps, and eight with primary suture, skin grafting, and conservative methods. In this large series, a consistent anatomy of the main pedicle of the anterolateral thigh flap was observed. In cutaneous and fasciocutaneous flaps, the skin vessels (musculocutaneous perforators or septocutaneous vessels) were found and followed until they reached the main pedicle, regardless of the anatomic position. There were only six cases in this series in which no skin vessels were identified during the harvesting of cutaneous or fasciocutaneous anterolateral thigh flaps. In 87.1 percent of the cutaneous or fasciocutaneous flaps, the skin vessels were found to be musculocutaneous perforators; in 12.9 percent, they were found as septocutaneous vessels. The anterolateral thigh flap is a reliable flap that supplies a large area of skin. This flap can be harvested irrespective of whether the skin vessels are septocutaneous or musculocutaneous. It is a versatile soft-tissue flap in which thickness and volume can be adjusted for the extent of the defect, and it can replace most soft-tissue free flaps in most clinical situations.

A 10-year retrospective study of free anterolateral thigh flap application in 872 head and neck tumour cases

“…3,4,[7][8][9][10][11] Doppler ultrasonography was used to assist in locating the perforator position before surgery. Surgical procedures consisted mainly of incision line design, localization of the perforators, and harvesting and preparing the ALT flaps.…”

“…Loco-regional flaps such as the platysma musculocutaneous flap and pedicled flaps like the pectoralis major myocutaneous flap have been used widely, while free flaps have undoubtedly heralded a revolution in head and neck reconstruction. [1][2][3][4][5] Progress in microsurgery has also made the free flap a more reliable choice.…”

“…Over the last several decades, numerous free flaps have been introduced and applied in oral and facial defects, including the free anterolateral thigh flap (ALT) and latissimus dorsi flap. 3,6 The introduction of the first free ALT flap in 1984 by Song gained worldwide attention, and many studies have since reported the features of the ALT flap. The donor site contains abundant soft tissues, and different types of flap can be harvested and tailed, such as fasciocutaneous, musculocutaneous, perforator, adipofascial, thinned ALT, deepithelialized, folded, and chimeric flaps.…”

Reconstruction of Pharyngeal Defects with a Submental Island Flap after Hypopharyngeal Carcinoma Ablation

“…In fact, there were no patients with cervical level I metastasis in our series and only 1 patient with a neck level II recurrence. It has been proposed that an ideal flap for head and neck reconstruction should possess extensive versatility, feasibility for anastomosis, be a time-saving procedure, and cause negligible donor site morbidity [24]. Because of the defect location and donor site, all in the same neck regions, the same surgical wound approach is possible (fig.…”

Anatomical variations and pre-operative imaging technique concerning the anterolateral thigh flap: guiding the surgeon

“…The tissue flap is known for its low donor site morbidity, can be quickly harvested with a large skin paddle and has the possibility for a long pedicle length. 2 The ALT flap can be used in a versatile way for example as a myocutaneous, fasciocutaneous, adipofascial flap, as a suprafascial flap or as a free flap. There is a possibility to preserve the lateral femoral cutaneous nerve with the possibility of providing flap sensation.…”