The Use of the Extended Anterolateral Thigh Flap for Reconstruction of Massive Oncologic Defects

BACKGROUND: Although the anterolateral thigh flap has been used extensively in reconstruction, the use of large or extended skin paddles (i.e., >240 cm) is thought to be associated with an increased risk of partial flap necrosis. This assumption may be attributable to cadaver perfusion studies of isolated anterolateral thigh flaps. The authors' clinical experience has shown, however, that significantly larger flaps can be reliably harvested based on the standard skin perforators. The purpose of this report was therefore to evaluate the authors' clinical experience with the extended anterolateral thigh flap for reconstruction of oncologic defects. METHODS: All consecutive patients who had undergone reconstruction of oncologic defects using an extended anterolateral thigh flap (defined as >or=240 cm) were identified. Patient characteristics and outcome data were analyzed. RESULTS: Fifteen patients met the inclusion criteria (flap size >240 cm) during the study period. The average size of the flaps was 341 cm (range, 240 to 480 cm). All flaps were perforator flaps and most had one perforator. In two patients, anterolateral thigh- and tensor fasciae latae-based perforators were used. There was one total flap loss on postoperative day 7 caused by recipient vessel spasm. One patient had partial necrosis of the distal portion of the flap with delayed healing. CONCLUSIONS: The anterolateral thigh flap is an excellent choice for massive defects requiring skin and soft-tissue coverage. The flap can be extended safely beyond the limit of 240 cm as suggested by cadaver perfusion studies. Inclusion of tensor fasciae latae perforators may increase the blood supply of the flap proximally; however, in general, a single perforator is capable of supplying a large area of the lateral thigh.