Use of Customized Thickness Anterolateral Thigh Flap in Head and Neck Reconstruction

Abstract

Objective: This study demonstrates different techniques of anterolateral thigh flap (ALT) with the appropriate surgical planes according to the thickness of the defect, which have not been previously found in the literature, with our reconstruction experiences. 
 Materials and Methods: A retrospective study was performed including 26 flaps in 25 patients who underwent reconstruction of head and neck defects with different surgical planes of ALT flap including subfascial, superthin, suprafascial, chimeric and composite flaps from March 2017 through December 2020. Flap planes were chosen according to the thickness of the defect, determined during surgery by using caliper. We evaluated the characteristics, flap thicknesses, complications and need of revision surgery in postoperative period. 
 Results: One of the superthin flaps was totally lost; there was not any other flap loss. Three patients died in postoperative period. Although appropriate plane of the flaps was chosen, 4 of all 26 flaps needed revision surgery. One of the patients who was performed lip reconstruction with superthin ALT flap had bulky appearance needed liposuction in postoperative 6 months and 3 patients who received subfascial ALT flaps were performed debulking surgeries. 
 Conclusion: ALT flap is a versatile, reliable flap which can be harvested in different planes according to the thickness of the defect in head and neck region. The ALT flap with convenient thickness provides definitive reconstruction in a single stage without revision surgeries and the most optimal aesthetic results can be obtained.