Refinement of the myocutaneous anterolateral thigh flap for reconstruction of frontonasal fistula defects

Abstract

Refinements in the myocutaneous ALT flap design have been illustrated to provide robust dead-space obliteration with vascularized muscle and reliable simultaneous scalp coverage in the treatment of frontonasal fistulas. © 2015 Wiley Periodicals, Inc. Head Neck 38: E552-E558, 2016.

Increasing Pedicle Reach with Musculocutaneous Perforator Dissection in Anterolateral Thigh Free Flaps

“…However, this approach increases the bulk of the flap and limits the total effective pedicle length (EPL) achievable, particularly when it is being passed through a subcutaneous, submuscular, or para/retropharyngeal tunnel, as is common during head and neck reconstruction. [7][8][9] Perforator dissection can effectively increase the maneuverability and reach of the pedicle as well as the available options for vascular anastomosis, thereby limiting the need for high-tension anastomoses or vein grafting. 10,11 Dissection of the musculocutaneous perforators can allow these vessels to be re-oriented in the axis of the pedicle, thereby increasing the effective distance of the vascular bundle without increasing the pedicle's width (Fig.…”

“…In many centers, the ALT is harvested as a nonperforator flap by taking a generous cuff of vastus lateralis muscle from inferior to the lowest perforator to superior to the most proximal perforator, when musculocutaneous perforators are present. However, this approach increases the bulk of the flap and limits the total effective pedicle length (EPL) achievable, particularly when it is being passed through a subcutaneous, submuscular, or para/retropharyngeal tunnel, as is common during head and neck reconstruction 7–9 …”