The role of the anterolateral thigh flap in complex defects of the scalp and cranium

Abstract

In this study, we introduced scalp reconstruction using free anterolateral thigh (ALT) flaps and evaluated postoperative outcomes in nine patients between March 2000 and April 2012. Five patients had problems of exposed prosthesis, three required reconstruction after resection of scalp tumor and one patient presented with third degree flame burns of the scalp. All flaps survived without re-exploration, except three flaps with tip necrosis requiring secondary procedures of debridement and small Z-plasty reconstructions. The superficial temporal artery and its concomitant vein were used as recipient vessels, apart from two cases where previous surgery and flame burns excluded these choices, for which facial arteries and veins were used instead. Primary closure of the donor-site was possible in six cases; with skin grafting performed for the other three patients. All donor sites healed without complications. The ALT flap offers the advantage of customizable size, option of fascia lata as vascularized dural replacement, and minimal flap atrophy typical of muscle flaps. Indications include very large defects, defects with exposed prosthesis, or defects with bone or dural loss. Our experience lends credible support to the use of customized free ALT flaps to achieve functional and cosmetically superior result for the reconstruction of large scalp defects, especially with bone exposure.

Anatomical comparison among the anterolateral thigh, the parascapular, and the lateral arm flaps

“…The anterolateral thigh, the parascapular and the lateral arm flaps have been commonly used as free flaps in head and neck reconstructions and in other areas . In 2013, Klinkenberg et al compared donor‐site morbidity, aesthetic and functional outcomes among these three flaps, but their morphological aspects were not analyzed .…”

Fascia-Only Anterolateral Thigh Flap for Extremity Reconstruction

“…3,12,13 In this manuscript, we have reviewed our experience with the fascia-only variation of this f lap specifically for extremity reconstruction. 3,12,13 In this manuscript, we have reviewed our experience with the fascia-only variation of this f lap specifically for extremity reconstruction.…”

The management of non-melanocytic skin malignancies of the scalp and calvarium

“…[19][20][21] If postoperative radiotherapy is necessary, fasciocutaneous coverage is preferable to muscle coverage with skin grafting because of the reliability and durability of cutaneous healing. [22,23] In thin patients, an anterolateral thigh flap is ideal because of its minimal donor-site morbidity and long pedicle length. For total scalp coverage, or in patients with a thick subcutaneous layer where an anterolateral thigh flap is inadequate, a LD muscle free flap with skin grafting may be preferable.…”

“…Alternatives such as the scapular flap, rectus abdominis flap and radial forearm flaps have been described but are limited to treating smaller sized defects. [19,[23][24][25][26] Our group was surgically treated; however, reconstruction with microsurgery is not always possible for reasons including advanced age of the patient, additional problems that increase the risk of anesthesia, extension of the duration of surgery. In these cases we chose to use scalp flaps if adequate for closure.…”