Reconstruction of Head and Neck Defects with Anterolateral Thigh Free Flap

Jeong, Han Sin; Baek, Chung Hwan; Lee, Hyun Jong; Kim, Tae Wook; Son, Young Ik; Mun, Goo Hyun; Lee, Hyeok Jun

Abstract

BACKGROUND AND OBJECTIVES
Anterolateral thigh flap (ALTF) has been reported to be very versatile and reliable for the head and neck reconstruction. The great concern in its operative technique is the anatomic variation of the perforators of the flap. The aim of study is to present our clinical experience using ALTF for the reconstruction of head and neck defects and to describe the anatomic variations of perforators among Korean patients. SUBJECTS AND METHOD: A retrospective study was conducted on patients who underwent ALTF reconstruction for their head and neck defects between April 2002 and April 2004. A total of 13 subjects (M: F=11: 2, mean age: 62 years) were considered for reconstruction after a wide surgical ablation of malignant tumors of the head and neck. The authors analyzed several items such as success rate, associated complications, characteristics of the flap, and morbidity of the donor site. RESULTS: All flaps were successfully transferred without any intraoperative complications. Partial necrosis occurred in 2 of 13 subjects, which were managed with conservative debridement and/or skin graft. As for vascular pedicles, musculocutaneous perforators from the descending branch of lateral circumflex femoral artery (LCFA) were found in 84.6% (11 of 13). In two cases (15.4%), the septocutaneous perforator from the descending branch of LCFA was the dominant supplier. The size of ALTF ranged from 8.0 to 16.0 cm in length, 4.0 to 8.0 cm in width, and 0.4 to 1.2 cm in thickness. Donor site complications were acceptable in all patients. CONCLUSION: Various types of head and neck defects were effectively managed with ALTF. We could overcome the anatomic variation of the perforators and most flaps were transferred without major complications and donor site morbidity. Further study on the anatomy of pedicles and refinements of surgical technique may make ALTF the workhorse of head and neck reconstruction.