Risk Factors for Donor-site Seroma Formation After Anterolateral Thigh Flap Harvest

The anterolateral thigh (ALT) flap is a versatile option for reconstructive surgery due to the availability of multiple tissue types and minimal donor-site morbidity. However, donor-site seroma formation remains a poorly understood complication, particularly with regard to its severity. In this study, we aimed to investigate the incidence, severity, and factors associated with seroma formation after ALT flap harvesting.

We conducted a retrospective analysis of 150 patients who underwent ALT flap harvest between November 2020 and September 2023. Donor-site seromas were graded using the Clavien-Dindo classification, and patients were divided into 2 groups based on the presence or absence of seromas. Logistic regression analysis was performed to identify independent factors associated with seroma formation.

Seroma formation occurred in 18.0% of patients. Most cases (70.4%) were classified as Clavien-Dindo grade 1, requiring only conservative management, whereas 29.6% (5.3% of all patients) were classified as grade 3a or higher, necessitating surgical intervention. Male sex (odds ratio, 3.11; 95% confidence interval, 0.97-9.98; P = 0.039) and fascia lata harvest larger than the skin paddle area (odds ratio, 2.93; 95% confidence interval, 1.26-6.82; P = 0.017) were identified as independent factors associated with seroma formation.

Fascia lata harvests larger than the skin paddle were associated with donor-site seroma formation with ALT flap harvests. Preoperative planning and careful fascia lata harvesting techniques are recommended to minimize complications.