Management of Intraoperative Failure of Anterolateral Thigh Flap Transplantation in Head and Neck Reconstruction

Abstract

The aim of the present study was to explore the remedial methods for the failure of anterolateral thigh (ALT) flap transplantation and to evaluate the efficacy of these methods in head and neck reconstruction. We performed a retrospective study of 11 patients who experienced intraoperative failure of ALT flap transplantation in head and neck reconstruction that was successfully salvaged with the same donor site. The cause of flap failure, corresponding management, and complications at the donor and recipient sites were recorded. All 11 patients were men with an average age of 56.5years. Of the 11 cases of flap preparation or transplantation failure, 1 was caused by arterial thromboembolism (after vascular anastomosis), 4 by perforator injury, 4 by mistaken perforator ligation, 1 by perforator thromboembolism, and 1 by the perforator deep penetration in muscle. All were successfully rescued with the same donor site, including harvest of another ALT flap with the other perforator in 5 patients, elevation of an anteromedial thigh flap in 4, and perforator anastomosis in 2 patients. With effective remedial methods for the failure of flap transplantation and their great versatility, the use of ALT flaps is a good choice for reconstruction of head and neck defects.