Alternative Choices for Anterolateral Thigh Flaps Lacking Suitable Perforators: A Systematic Review

Area of Science:

• Microsurgery
• Reconstructive Surgery
• Anatomical Studies

Background:

• The anterolateral thigh (ALT) flap is a common reconstructive option.
• Anatomical variations in perforators can complicate ALT flap harvesting.
• Alternative flaps like tensor fasciae latae (TFL) and anteromedial thigh (AMT) are sometimes used.

Purpose of the Study:

• To systematically review and compare the reliability of TFL and AMT flaps.
• To evaluate perforator characteristics when ALT flap harvest is not feasible.

Main Methods:

• Systematic literature review of MEDLINE, PubMed, and Cochrane Library.
• Comparison of perforator characteristics (number, pedicle length, diameter) for TFL and AMT flaps.

Main Results:

• TFL flaps had a mean of 2.53 perforators (range 1.41-3.17) compared to 0.90 for AMT flaps (range 0.59-1.3).
• Mean pedicle length was comparable (TFL: 7.0-9.59 cm; AMT: 7.4-11.0 cm).
• Mean perforator diameter was similar between TFL and AMT flaps.

Conclusions:

• The tensor fasciae latae (TFL) flap appears to be a more reliable alternative.
• This is particularly relevant when adequate perforators for ALT flap harvest are not identified.