Rationale for Reconstruction of Large Scalp Defects Using the Anterolateral Thigh Flap: Structural and Aesthetic Outcomes

Abstract

The advent of free tissue transfer has provided multiple options that allow preservation and maintain both the structural and aesthetic status of the scalp. Since the first report of the anterolateral thigh flap in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. Eleven free anterolateral thigh flaps were used to reconstruct soft-tissue defects of different regions of the scalp. Two of these flaps were used for the occipital region, six for temporal regions, two for the frontoparietal midline region, and the remaining flap for a defect of the forehead. The study consisted of 10 males and one female whose ages ranged from 18 to 82 years (mean age: 52.5 years). Six patients had primary or recurrent cancer, four had acute or subacute wounds resulting from trauma or craniotomy, and one had high-tension electrical burn injury. The size of the flaps ranged from 14 to 27 cm in length and from 6 to 18 cm in width. The overall flap success rate was 100%. In two cases, primary thinning of the flap was performed to reconstruct a tissue defect of the temporal region in one patient and a forehead defect in the other. In two patients, the fascial layer of the flap was used as a source for a vascularized fascial flap to cover defects of the dura mater. No secondary corrections, including debulking procedures or scar revision, were necessary. No infections or hematomas were observed. Six cases underwent split-thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed directly. No donor-site morbidity was observed. The authors conclude that with its evident structural and cosmetic advantages, the anterolateral thigh flap can be considered an excellent flap option for most scalp defects.

Microvascular Free Tissue Transfer in the Reconstruction of Scalp and Lateral Temporal Bone Defects

“…In the future, we may employ this flap more frequently when the donor site thickness is appropriate, as it can be harvested with ease, without turning the patient, and has been used successfully by others for this application. 16 In our opinion for the majority of scalp defects, the latissimus dorsi muscle flap with a skin graft still provides the optimal contour and aesthetics.…”

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,…”

One Stage Reconstruction of Skull Exposed by Burn Injury Using a Tissue Expansion Technique

“…Furthermore, a defect that has some possibility of residual tumor in the wound bed is not a good candidate for local flap coverage. In case of nearly total defect in the scalp, distant flaps as various as anterolateral thigh flap, latissimus dorsi muscle flap, radial forearm free flap, transverse rectus abdominus myocutaneous flap can be used [4-6]. …”