The Versatility of the Anterolateral Thigh Flap

Abstract

In the last two decades, the anterolateral thigh flap has emerged as one of the most popular reconstructive options for multiple body sites. Based on a perforator flap harvest concept, the flap encompasses the advantages of versatility, pliability, and potential for composite tissue replacement. Although numerous anatomical variations exist, these are well-described, and flap safety remains uncompromised if certain anatomical boundaries are respected. Careful preoperative planning and identification of perforators remain the cornerstone of successful flap harvest. Once perforators are identified, variations in skin paddle design allow for multiple skin paddle configurations, central or eccentric orientations, and custom-made flaps tailored to fit almost any defect. A suprafascial dissection allows for "ultra-thin" flaps ideal for folding, tubing, or packing purposes. The versatility of the lateral circumflex femoral artery branches can be exploited to include muscle, iliac bone, tendon, fascia, or nerve in extended designs. The anterolateral thigh flap is currently the frontline choice for head and neck reconstruction, including intraoral, mandibular-maxillary, tongue, and facial defects, and is gaining popularity in abdominal and pelvis reconstruction. It can also be used as a pedicled flap in phallus or perineum reconstruction. More recently, the flap has proved to be extremely useful in skin resurfacing and even functional reconstruction in traumatic wounds. This review summarizes the anatomy, planning, flap harvest, donor morbidity, and clinical applications of the anterolateral thigh flap. An algorithm is proposed that facilitates a clear, problem-based approach for the use of this versatile reconstructive option.

Anterolateral Thigh Twin Free Flaps from a Single Donor Site—a Modification Based on the Oblique Branch of the Lateral Circumflex Femoral Artery

“…With increased clinical application, the flap has undergone several modifications in terms of size, components, vascularity and design according to the need [4]. Hemi thigh flap [5], giant thigh flap [6], extended ALT flap [7] and combined anterolateral and anteromedial thigh flaps [8] are notable modifications which were used to reconstruct large defects.…”

Secondary Extremity Reconstruction for Contour Deformity: Case Report

“…The ALT flap has a long and sizeable pedicle, predictable anatomy and provides an opportunity to implement a twoteam approach, thus minimizing the duration of surgery and minimal donor-site morbidity. [7][8][9] However, its suitability for extremity, particularly post-traumatic reconstruction, has only recently been appreciated. [10][11][12][13] Therefore the ALT flap was our flap choice for its previously mentioned advantages.…”

Reconstruction of Groin Defects Following Radical Inguinal Lymphadenectomy: An Evidence Based Review

“…Alternatively, this flap may be defined by its tissue components: skin, fat, fascia, tendon, muscle, or nerve (suprafascial, fasciocutaneous, adipofascial, and musculocutaneous anterolateral thigh flaps) [16]. Each variant is equipped with well defined indications according to the recipient site [17]:…”