Anterolateral Thigh Perforator Flaps in Head and Neck Reconstruction

Microsurgical free tissue transfer has revolutionized head and neck reconstruction. It allows functions and esthetics to be preserved without compromising the principles of oncologic surgery. To this end, the anterolateral thigh (ALT) flap has recently gained increasing popularity. This article reviews the advantages of the ALT flap, its anatomy, and various methods of its elevation. We have successfully utilized the ALT flap for reconstructing a wide range of complex head and neck defects; a selection of our methods are outlined herein. Additionally, various configurations of the ALT flap, including the elevation of two independent cutaneous flaps from the same pedical, chimeric, and flow-through flaps, are described. The unique anatomy of the thigh allows unparalleled flexibility in flap design, useful for reconstructing defects of the tongue, buccal region, mandible, midface, scalp, and through-and-through defects of the cheek. Resultant donor site morbidity is low in comparison to other flaps that are commonly utilized for head and neck reconstruction.