Abstract
We report a retrospective review of 34 cases in which we used anterolateral thigh (ALT) flaps over the last 7 years and 10 months. We did not perform preoperative image analysis of the vascular pedicle in all cases. We searched for perforators and elevated flaps under the fascia with the naked eye. We were able to harvest 32 flaps (94.1%) in 34 cases. In these 32 cases, 26 free flaps were raised (81.3%), and the remaining 6 were pedicled flaps (18.8%). One case (3.8%) of free flap resulted in total necrosis. The mean number of perforators included in a single skin paddle was 2.0 (range, 1-4), and 68.8% of cases had multiple perforators. The maximum area of skin paddle (length × width) was 31 × 22 cm, and the minimum was 2 × 1.5 cm. We were able to elevate the lateral half of the thigh as a skin paddle with one perforator. Sixty of the 65 perforators (92.3%) were musculocutaneous and 5 (7.7%) were septocutaneous. We were able to harvest flaps in both cases. The number of descending branches of the lateral circumflex artery included was 0 in 4 (11.8%) of the 34 cases. However, we could make flaps using the muscular branch to the vastus lateralis in these 4 cases. We conclude that an ALT flap can always be harvested without preoperative image analysis of the vascular pedicle, and even the presence of only one perforator offers a reliable blood supply to feed a large skin paddle. We believe that anatomical variations of vascular pedicles or difficulties in dissection of the pedicle can be overcome with the accumulation of such information and simplification of the operative processes.
