Feasibility and Monitoring of a Free Myofascial Anterolateral Thigh Flap in Head and Neck Reconstruction

Abstract

Objectives: 1) Explore the feasibility of a free anterolateral thigh myofascial flap as a reconstructive option in patients with large body habitus. 2) Present a prospective case series of patients in which this flap was successfully utilized for head and neck reconstruction. First introduced in China, the anterolateral thigh free flap is being increasingly used in head and neck reconstruction. However, patient body habitus, particularly in North American patients, can contribute to flap bulkiness and pose a significant surgical challenge. Methods: In a prospective case series, feasibility and results using a myofascial anterolateral thigh free flap were studied, an option previously unpublished in the head and neck reconstructive literature. We present five cases of its successful use in a variety of reconstructive situations. It was utilized twice for hemiglossectomy, once for scalp reconstruction, and twice for skull base defects. Results: All five flaps survived. Primary monitoring was conducted routinely via needle prick of the myofascial flap or direct muscle inspection. No complications were encountered at the harvest or reconstructive site. The fascial flap was well vascularized and muscle remained viable, while atrophy occurred in follow up. Conclusions: The anterolateral thigh myofascial flap is a versatile composite tissue flap that allows the use of the anterolateral thigh site in patients with larger body habitus. It can be monitored using routine techniques with good reliability. This flap may have applications in cases where radial forearm or rectus may have been used but forearm or abdominal wall harvest morbidity is undesirable.