Versatility of the Free Multipedicled Anterolateral Thigh Flap for Restoring Complex Facial Soft Tissue Defects

Complex soft tissue injuries in the facial area can arise from various causes. Surgeons face significant challenges when reconstructing these injuries, as they must select appropriate materials based on texture and color, while also considering their composition and properties. The anterolateral thigh (ALT) flap has emerged as a versatile option in clinical reconstructive surgery, offering many advantages over other free flaps. One of its main advantages is the ability to create a multicomponent chimeric flap, allowing for the reconstruction of various complex facial defects.

Our study utilized the ALT flap to create a chimeric type for reconstructing complex facial defects. The authors conducted a retrospective case series involving 23 consecutive patients who underwent facial reconstruction using the multiple-paddle ALT flap.

The mean number of perforators was 1.2. Of these, 48 perforators originated from the ipsilateral descending branch of the lateral circumflex femoral artery, 3 from the ipsilateral oblique branch, and 3 from the contralateral descending branch. The average thickness of the 45 skin flaps was 24.6 mm (ranging from 16-31 mm). The authors thinned 41 flaps, achieving an average thickness of 6.8 mm. A total of 42 flaps were used for coverage, 5 skin and fascia flaps were utilized for lining, and 2 muscle flaps were used for tissue filling. Donor sites were primarily closed in 19 cases, while skin grafts were used in 6 cases. Complications occurred in 4.0% of the cases, with one flap experiencing total necrosis.

The ALT flap remains an exceptional choice for complex facial defects due to its diverse components and the ability to create a multipedicled flap. This multipedicled flap effectively helps to recreate multiple units lost simultaneously. Understanding the concept and techniques for creating a suitable multipedicled ALT flap is crucial for achieving successful outcomes.