Technique and Strategy in Anterolateral Thigh Perforator Flap Surgery, Based on an Analysis of 15 Complete and Partial Failures in 439 Cases

Double-skin paddle perforator flap from the lateral lower leg for reconstruction of through-and-through cheek defect – a report of two cases

“…The thinning procedure, which is easier or often not necessary in perforator flaps than in other free-flaps, can lead to impairment of circulation or direct injury of the perforating vessel 5,16 .…”

The early use of a perforator flap of the lateral lower limb in maxillofacial reconstructive surgery

“…The greatest experience is reported from WEI's group, who uses perforator-based flaps from the anterolateral thigh 6,10,16,20 . KOSHIMA et al reported on facial contour augmentation and closure of huge facial defects after resection of arteriovenous malformations using paraumbilical and anterolateral thigh (ALT) perforator flaps 14,15 .…”

“…Because of the well-known variability of cutaneous perforators in number and location, the transfer of perforator-based flaps is also described as 'free style microsurgery' 22 . Meanwhile, perforator-based flaps are raised from many different donor sites such as the thigh 6,7,16,20 , back 12 , abdomen 3,13 , the buttock 1 , forearm 4 , or the lower leg 14,11 . Preoperative mapping of the perforating vessels using Doppler sonography or colour Doppler duplex imaging can help to facilitate flap raising 9,17 .…”

Perforator flaps in head and neck surgery

“…Initially it was thought that reliable perforators to the skin might not be found in 5% of cases, and this may have led to the initial unpopularity of this flap. It is suggested that suitable perforators are not available in less than 1% 202 Lyons of cases 11 . In the past, this figure was thought to be much higher and this is probably why the technique remained dormant for 2 decades.…”