gms | German Medical Science

Introduction: The anterolateral thigh flap (ALT) is pedicled on septocutaneous or musculocutaneous perforators of the descending branch of the lateral circumflex femoral artery. Due to its extraordinary versatility and low donor site morbidity it has gained increasing popularity in the treatment of oral and maxillo-facial defects after ablative surgery in the last decade. The anterolateral thigh flap allows the generation of subcutaneous, fasciocutaneous, myocutaneous, or adipofascial flap, which has made it to a work-horse in reconstructive maxillo-facial surgery.

Material and methods: The aim of the present retrospective analyses of a collection of n=97 cases, which were treated in 2 highly specialized institutions for cranio-maxillo-facial surgery, was to illustrate the intriguing applications of the ALT flap as well as the clinical robustness and excellent functional outcome of this approach.

Results: The overall flap failure rate was low in this patient series (9/97) and comparable to other free flaps utilized in the head and neck area like the radial forearm flap. It was successfully used for reconstruction in case of oral cavity, oropharynx, external skin and maxilla defects. For more bulky reconstructions after total parotidectomy or skull base surgery, a muscle component was frequently harvested and transferred additionally. When a thinner, more pliable flap was required for the reconstruction of the floor of the mouth, suprafascial anterolateral thigh flaps were raised or the flaps were thinned after harvesting.

Conclusion: In conclusion, the anterolateral thigh flap is a highly versatile and reliable flap for use in the reconstruction of various soft tissue defects of the head and neck area. This flap has gained great popularity given its versatility, ability for a two-team approach, and minimal donor site morbidity.