Extended Anterolateral Thigh Flaps: Maximum Size for Covering Cancerous Defects

The anterolateral thigh perforator flap is frequently used for massive soft-tissue defect reconstruction. Cadaver perfusion examinations of isolated anterolateral thigh flaps have suggested a maximum skin area that may be vascularized based on the perforating vessels (ie, 250 cm 2 ). Therefore, this study aimed to evaluate a series of consecutive cases involving use of extended anterolateral thigh flaps for oncologic reconstruction of massive soft-tissue defects. To our knowledge, this is the largest study of extended anterolateral thigh flaps at a single center.

Patients who underwent transfers of anterolateral thigh flaps exceeding 250 cm 2 at our institution between April 2018 and December 2022 were retrospectively identified. The operative data and results were analyzed.

Thirty-eight flaps in 36 cases were included. The 38 flaps consisted of 31 free flaps and 7 pedicled flaps. The average skin paddle size was 363 ± 101 cm 2 (range, 250-660 cm 2 ). The donor site was primarily closed in 7 flaps. The remaining 31 flaps required skin grafting to ensure donor-site closure. Neither total nor partial flap loss was observed. Four patients had wound dehiscence due to tightness. Three patients had surgical-site infections. Two patients had seromas. The postoperative courses of the 5 patients were complicated by partial skin graft loss at the donor sites.

The anterolateral thigh flap is versatile and reliable for the treatment of massive oncological defects. Even flaps much larger than 250 cm 2 can usually be harvested safely based on 2 to 4 perforators without special techniques, such as compound flaps or additional vessel anastomoses.