The versatility of the anterolateral thigh flap in lower extremity reconstruction

The anterolateral thigh flap (ALT) has emerged as one of the major workhorses in lower extremity reconstruction. As knowledge of the local anatomy and familiarity with intramuscular dissection has grown, so has the multitude of applications of the ALT flap. Its abundance of tissue, long and large caliber pedicle, minimal donor site morbidity, and the ability to use a two-team approach affords the surgeon with a reliable reconstructive option. The variety of tissues that may be harvested from the lateral circumflex femoral axis can provide like-with-like tissue replacement for most components in the lower extremity. Some of the creative applications successfully reported include flow-through flap for revascularization, vascularized fascia lata for single-stage tendon reconstruction, functional muscle transfer, sensate flaps, and chimeric flaps for extensive composite defects. The following article summarizes our technique for reliable flap harvest, a thorough review of both the benefits and limitations of the anterolateral thigh flap, and a review of its many applications reported in the international community.