Incidence of inadequate perforators and salvage options for the anterior lateral thigh free flap

Objective The anterolateral thigh (ALT) free flap is a soft tissue flap used in head and neck reconstruction. Occasionally, its perforators to the skin paddle are absent or too small to support the flap. Salvage options in this scenario have not been well described for head and neck reconstruction....

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Bibliographic Details
Published in:The Laryngoscope 2020-02, Vol.130 (2), p.343-346
Main Authors: Thomas, William W., Calcagno, Haley E., Azzi, James, Petrisor, Daniel, Cave, Taylor, Barber, Brittany, Miles, Brett, Gomez, Ernest D., Cannady, Steven, Bhadkamkar, Mohin, Hanasono, Matthew M., Wax, Mark K.
Format: Article
Language:English
Subjects:
Anterolateral thigh
free flap
free tissue transfer
Head and neck reconstruction
Maxillofacial surgery
Skin & tissue grafts
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Summary:Objective The anterolateral thigh (ALT) free flap is a soft tissue flap used in head and neck reconstruction. Occasionally, its perforators to the skin paddle are absent or too small to support the flap. Salvage options in this scenario have not been well described for head and neck reconstruction. Methods Multicenter review of 1,079 cases of planned ALT flaps where 28 initial flaps (2.6%) were discarded for nonviable skin paddle or lack of cutaneous perforators. Iatrogenic perforator injury was calculated separately. The total flap loss rate was 3.2%. Results In 12 cases, no perforators were noted after performing the anterior incision (early). Sixteen ALT flaps were discarded immediately before pedicle ligation (late). Reconstruction was salvaged by seven anteromedial thigh (AMT), six radial forearm, five contralateral ALT, four rectus abdominus myocutaneous, three vastus lateralis, three profunda artery perforator, two tensor fascia lata, one rectus femoris, two pectoralis major, one cervicofacial rotational, and one fibula flap. Of the 28 cases, 12 salvage cases did not involve an additional wound for the patient. Five of the seven AMT flaps were harvested after the ALT was identified as nonviable in the early time point. Two patients had no viable ALT flaps on bilateral lower extremities. Conclusion The ALT flap is a reliable soft tissue flap, and rarely cutaneous perforators are not adequate to support the skin paddle. Multiple options exist to salvage the reconstruction without significant additional morbidity to the patient if said inadequacy is identified early. Level of Evidence 4 Laryngoscope, 130:343–346, 2020
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.28176