Delayed Split Anterolateral Thigh Flap as a Versatile Alternative in Head and Neck Malignancy Reconstructions

Background Reconstruction of complex head and neck defects using a single flap is challenging in the absence of multiple reliable perforators for immediate splitting. Conventional folding or de-epithelization in the middle often results in unfavorable bulkiness and drooling. A delayed split above the superficial fascial level may offer a practical alternative. Methods A retrospective review of delayed-split anterolateral thigh flaps for head and neck reconstructions was conducted between December 2018 and December 2023 at E-Da Hospital. Defect types, perforator patterns, intervals to secondary split, flap survival, and postoperative complications were analyzed. Results Thirty delayed-split anterolateral thigh flaps were identified ( n = 28 without multiple perforators). The mean interval to secondary split was 10.7 days (range: 6–18 days). All flaps survived the 2-stage manipulation, with 4 cases of partial necrosis and 1 requiring additional regional flap coverage. Conclusions A 2-stage delayed anterolateral thigh flap split within 2 weeks is technically feasible and achieves favorable outcomes.