A review of the advantages of the anterolateral thigh flap in head and neck reconstruction

Abstract

The anterolateral thigh flap was originally described by Song in 1984 as a septocutaneous flap based on the descending branch of the lateral circumflex artery. It was later determined that in the majority of cases the flap was supplied only by musculocutaneous perforators and septocutaneous supply only occurred in a small percentage of case. In the past, the variable anatomy and the necessity for intramuscular dissection of perforators has given this flap the reputation of requiring a relatively difficult dissection. In recent years, advances in perforator flaps have provided familiarity of the technique required for safe dissection and in turn this has popularised the use of this flap for a wide variety of indications. Koshima et al. and Kimata et al. first described the use of this flap for the reconstruction of head and neck defects. Further reports have outlined the utility of this flap in head and neck reconstruction since it may be adapted to cover most defects of the face, neck or intraoral regions. –12 The flap may be thinned for pure intraoral defects. It also has good pliability and may be folded for the reconstruction of both the inner and outer lining of through and through defects. The vascular pattern also allows the use of a more versatile design with double skin paddles based on multiple perforators. In addition, the flap may be used in combination with vastus lateralis muscle as a myocutaneous flap or combined with adjacent flaps according to the chimaeric flap principle to reconstruct large or complex 3-dimensional defects. It is the aim of this article to describe the advantages of the use of this flap for reconstruction of a wide variety of head and neck defects.