Anterolateral thigh flap: an ideal soft tissue flap

Microsurgical reconstruction has evolved to a stage where a nearly 100% success rate has been achieved. Therefore, refinement of the functional and aesthetic result, as well as a decrease in donor site morbidity have become the major concerns. The anterolateral thigh flap meets these requirements; its wide application to various fields is based on the following charateristics. Its reliable vascularity. Its vascular pedicle is long and large, at least 8 cm (can be 20 cm). Flap territory is large and easy to design. The pedicle can be at the periphery of the flap. Its length can be 40 cm and its width can be half of the thigh, with the maximal dimension as large as 40 x 20 cm (800 cm2). Primary trimming of the flap to 3 mm to 5 mm in thickness does not compromise its vascularity. The subcutaneous fat can be included to facilitate gliding of the underlying tendons. To harvest chimeric flaps, the following components can be included: muscles, fascia and bone (an osseous flap can be joined to the flap with microvascular anastomoses). A two-team approach is possible, because the recipient site is usually far away from the donor site. Usually it does not require that the patient change position. It can be closed primarily without skin graft if its width is less than 8 cm. The donor site is easily covered with clothes, and the motor function is least affected. Care should be taken in flap dissection, inset, and postoperative care, as well as strategies for re-exploration.