Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation

Thirty-seven consecutive free anterolateral thigh flaps in 36 patients were transferred for reconstruction of head and neck defects following cancer a blation between January of 1997 and June of 1998. The success rate was 97 p ercent (36 of 37), with one flap lost due to a twisted perforator. The anat omic Variations and length of the vascular pedicle were investigated to obt ain better knowledge of anatomy and to avoid several surgical pitfalls when it is used for head and neck reconstruction. The cutaneous perforators wer e always found and presented as musculocutaneous or septocutaneous perforat ors in this series of 37 anterolateral thigh flaps. They were classified in to four types according to the perforator derivation and the direction in w hich it traversed the vastus lateralis muscle. In type I, vertical musculoc utaneous perforators from the descending branch of the lateral circumflex f emoral artery were found in 56.8 percent of cases (21 of 37), and they were 4.83 +/- 2.04 cm in length. In type II, horizontal musculocutaneous perfor ators from the transverse branch of the lateral circumflex femoral artery w ere found in 27.0 percent of cases (10 of 37), and they were 6.77 +/- 3.48 cm in length. In type III, vertical septocutaneous perforators from the des cending branch of the lateral circumflex femoral artery were found in 10.8 percent of cases (4 of 37), and they were 3.60 +/- 1.47 cm in length. In ty pe IV, horizontal septocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 5.4 percent of cases (2 of 37). They were 7.75 +/- 1.06 cm in length. The average length of vascul ar pedicle was 12.01 +/- 1.50 cm, and the arterial diameter was around 2.0 to 2.5 mm; two accompanying veins varied from 1.8 to 3.0 mm and were suitab le for anastomosis with the neck vessels. Reconstruction of one-layer defec t, external skill or intraoral lining, was carried out in 18 cases, through -and-through defect in 17 cases, and composite mandibular defect in two cas es. With increasing knowledge of anatomy and refinements of surgical techni que, the anterolateral thigh flap can be harvested safely to reconstruct co mplicated defects of head and neck following cancer ablation with only mini mal donor-site morbidity.