Anterolateral thigh flap for the reconstruction of head and neck defects: alternative or replacement of the radial forearm flap?

This paper presents our clinical experience with head and neck reconstruction using radial forearm flap and our preliminary experience with anterolateral thigh (ALT) flap. We analyze the advantages and disadvantages of these 2 flaps from the complications we have encountered. From 1993 to 2006, the radial forearm flap has been used in 75 patients, whereas we began using the ALT flap in 2006. Since this time, we have used the ALT flap in 10 patients. One flap partial loss was observed in a patient who underwent reconstruction of the ethmoid region and nasal bones with an osteofasciocutaneous radial flap. In one patient who underwent reconstruction with ALT flap, inadequate venous outflow was discovered, and the flap was salvaged with reexploration, removing of the cutaneous component of the flap and using antithrombotic agents. Donor-site complications were experienced in 8 of 75 patients who underwent reconstruction with radial forearm flap, whereas all donor thighs healed uneventfully. Anterolateral thigh flap gives optimal results either at the donor site or at the accepting site, being easy to harvest and providing an ideal reconstructive option. Nevertheless, radial forearm flap remains a valuable alternative in case of a thin soft tissue reconstruction because of its thinness and versatility; furthermore, it can provide a long and constant pedicle of large caliber. However, since we began using the ALT flap, we had only performed this flap with respect to radial forearm flap because of its lower donor-site morbidity.