Anterolateral thigh free flap for "head-to-toe" reconstruction

Since its conception the anterolateral thigh (ALT) free flap has become a cornerstone in the reconstruction of complex head and neck defects. It has quickly gained further uses because of its variability in size, malleability, 2-team approach to the operation, and low-morbidity donor site. The ALT lends itself well to reconstructing complex defects throughout the body, from the lower extremities up to the head and neck, and a variety of indications, from oncologic defects to burns and traumatic injuries. Twenty patients (18 male, 2 female; average age 57.74 years [range, 17-86 years]) had ALT free-flap harvest for scalp defects (5), trunk defects (1), head and neck defects (11), lower extremity defects (3). Sixteen patients had oncologic-related defects, 2 from traumatic injuries, and 2 from burn-related injuries. The average flap area was 157 cm, the average number venous anastomoses was 1.47, and the average vein diameter was 2.65 mm (range, 1.5-3.5 mm). The objective of this article is to review our institutional review board-approved case series at the University of Florida and further elucidate the widespread adaptability of the ALT flap. We share our experience in indications for use, recipient-site variables, donor-site management, complications, and outcomes. We also review other applications of this useful flap described in the literature.