Aesthetic and functional advantages of the anterolateral thigh flap in reconstruction of tumor‐related scalp defects

Abstract

Eleven patients underwent free-flap reconstruction of tumor-related defects of the scalp, forehead, and temporal region. Flap selection aimed at achieving acceptable functional and aesthetic results combined with negligible donor-site morbidity. Ten males and one female, aged 61.3 +/- 14.3 years, were included in this study. Eight patients presented with tumor recurrences after previous surgery, irradiation, and/or chemotherapy. The average extension of defects was 169.5 (range, 30-600) qcm. Free flaps employed for reconstruction included antero-lateral thigh flaps (8), suprafascial radial forearm flap (1), lateral arm flap (1), latissimus dorsi muscle flap (1), and myocutaneous vertical rectus abdominis flap (1). Other procedures included nerve grafts to the facial nerve (2), ectropion correction (2), and fascia lata slings for static procedure in facial palsy (2). There was no pedicle revision and no flap failure. Donor-site morbidity was negligible. Hospitalization averaged 9.2 +/- 1.7 days. The anterolateral thigh perforator flap offers excellent coverage of tumor-related defects of the scalp, which require a thin flap for adequate contouring. The customized harvested myocutaneous anterolateral thigh flap is regarded as an elegant option for covering defects which consist of both deep and superficial areas. Fascia lata and nerve grafts are available at the same donor site. This easily allows additional procedures for cosmetic and functional improvement that are of high benefit for patients.

Anterolateral Thigh Flap Reconstruction of Large External Facial Skin Defects: A Follow-Up Study on Functional and Aesthetic Recipient- and Donor-Site Outcome

“…7,11,14,15,18 One explanation for this difference is that most flaps in the current study were much wider than 8 cm, above which primary closure is usually impossible. Another explanation for this difference is that in a number of flaps a rather proximal perforator was chosen to be the most adequate for flap perfusion.…”

“…details on flap color mismatch. 14,18 In contrast, various skin-bearing flaps and skin-grafted muscle flaps, with or without irradiation, have problems with color match in the head and neck area. 19,20 Flap bulkiness (50 percent) was another common objective aesthetic outcome at followup.…”

“…Except for the latter, the anterolateral thigh flap 8 has been suggested to have all of these qualities, 9 which prompted us to start using this flap for reconstructing large skin defects of the face and forehead after malignant tumor resection. Although others have used the anterolateral thigh flap for this purpose, mainly in an Asian population, 7,10 -13 objective follow-up studies on functional and aesthetic outcomes of the recipient site 14,15 or donor site 16,17 are scarce. Another study presented the results of the anterolateral thigh flap in reconstructing various head and neck defects in 34 white North American patients; however, no details on functional or aesthetic outcome were given.…”

Scalp Reconstruction

“…19 Other flap options for medium to large defects include the radial forearm, anterolateral thigh (ALT), gracilis, lateral arm, parascapular, rectus abdominis, Scarpa adipofascial flap, and omental flaps. 18,[64][65][66][67][68][69][70][71][72] It should be noted that in cases of latissimus dorsi or rectus muscle flaps, only the muscle is taken and not the overlying skin, because the subcutaneous fat is often too bulky and provides poor scalp contour. It is for this reason that skin grafting is performed over the muscle.…”

Invasive giant basal cell carcinoma of the head: case report, reconstruction choice and literature review

“…Fine characteristics of this flap are: versatility in design, adequate tissue supply, superior texture, minimal donor-site morbidity, large and long pedicle, feasibility of two-team approach, and enables simultaneous dural reconstruction. However, the donor site requires skin graft if the taken flap is larger than 10-11 cm [19,20].…”