Refining the Anterolateral Thigh Free Flap in Complex Orbitomaxillary Reconstructions

Maxillary reconstruction using anterolateral thigh flap and bone grafts

“…Donor site morbidity is typically less than with the rectus abdominis free flap, without a risk for abdominal hernia. The use of ALT flap has been widely described in literature and today is worldwide considered as the first choice for several kind of defects reconstruction: RodriguezVegas et al 17 reported its use without bone grafts in reconstruction of complex orbitomaxillary defects supporting the flap reliability for such reconstructions; Agostini et al, 18 Valentini et al, 19 and Chen et al 20 confirmed the ALT application in oral cavity reconstruction, underlining the versatility of the flap for the restoration of the internal oral lining. Other authors, such as Malata et al 21 and Amin et al, 22 reported their experience with ALT flap for skull base and craniofacial defects reconstruction, focusing on the large amount of well revascularized tissue provided used for the filling of the death spaces, the low rate of complications and the stability of the results obtained.…”

Maxillary reconstruction: Current concepts and controversies

“…The free soft tissue flaps described are radial forearm flaps,[27] rectus abdominis,[28] Anterolateral thigh flap[2930] and DIEP flaps. [31] The main objective of reconstruction using these flaps has been to seal the palatal defects.…”

Reconstruction of the midface and maxilla

“…It should be noted that in Brown and Burke [20] as well as Rodriguez-Vegas et al [30] the reconstructive techniques did not address the bony skeleton of the maxilla.…”

“…Brown and Burke [20] also reported in their series that including fascia or skin with the rectus abdominis free flap could restrict the unpredictable atrophy (30-70%) associated with denervated muscle flaps. Vegas-Rodriguez et al [30] described the use of a myocutaneous anterolateral thigh free flap for reconstruction of complex orbitomaxillary defects, due to the adequate pedicle length and vessel caliber.…”

“…A variety of donor sites providing soft tissue only or soft tissue with bone have been described in the literature, including the radial forearm [14][15][16][17][18], rectus abdominis [19,20], fibula [21][22][23][24], scapular [25][26][27], iliac crest [28,29], and anterolateral thigh [30,31] systems of free flaps. In all cases of midfacial reconstruction, the individual characteristics of the defect and the patient will guide which type of reconstruction is undertaken.…”