Article ID: 2025-0011
Objectives: This study aimed to elucidate the incidence of anterolateral thigh (ALT) flap failures attributable to perforator complications, distinct from issues with microvascular anastomoses or proximal vascular pedicles.
Methods: A retrospective chart review was conducted for 663 free ALT flap transfers for head and neck reconstruction between 1995 and 2024. Data on failed flaps were analyzed.
Results: There were 41 flap failures, generating an overall success rate of 93.8%. Of these, 18 (43.9%) were due to perforator compromise, whereas the remaining 23 (56.1%) stemmed from anastomotic or proximal pedicle complications. The 18 perforator-related failures predominantly occurred after hemiglossectomy (7 cases) and marginal mandibulectomy (5 cases). Flaps in 14 cases were harvested with the vastus lateralis muscle; 13 involved a single skin perforator, and others contained 2 skin perforators. Perforator skeletonization was performed in 12 cases.
Conclusions: Perforator compromise is a major cause of ALT flap failure in addition to problems with microvascular anastomoses or proximal vascular pedicles. Countermeasures such as avoiding perforator skeletonization and including multiple perforators in the skin paddle may be effective in preventing these complications.
