The Extended Pedicle Anterolateral Thigh Flap And Its Application In Scalp Reconstruction
Gregory A. Lamaris, MD, PhD, Rebecca Knackstedt, MD, PhD, Nasim Abedi, BSc, MD, Brian Gastman, MD.
The Cleveland Clinic Foundation, Cleveland, OH, USA.
Large soft tissue defects of the scalp can present difficulties in reconstruction. The ideal flap for scalp reconstruction has yet to be described although the latissimus dorsi flap is frequently referred to as the first choice for reconstruction in this setting.
Following institutional review board approval, we reviewed our experience in scalp, maxillary and base of skull microsurgical reconstruction in the past 4 years. Patient demographics, indication for reconstruction, flap choice, complications as well as long term outcome were recorded.
A total of 24 patients underwent anterolateral thigh free flap reconstruction for maxillary and base of skull as well scalp coverage. In the majoriy of cases the indication for reconstruction was resection of a cutaneous malignancy. In most cases the facial artery and vein were used for anastomosis, while the superficial temporal vessels were used only in two cases. None of the cases required the use of vein grafts to increase pedicle length. One of 24 flaps failed and required salvage reconstruction with a latissimus dorsi flap.
The anterolateral thigh flap can emerge as a viable alternative to the latissimus dorsi flap in scalp reconstruction, obviating the need for vein grafting even when the proximal neck vessels are used as the recipient targets. The anterolateral thigh flap can provide a durable skin island that can withstand adjuvant radiation and can simplify monitoring for tumor recurrences. This is the first study highlighting the ALT flap as a bone fide alternative to the LD in scalp reconstruction.
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