The anterolateral thigh flap: radial forearm's "big brother" for extensive soft tissue head and neck defects.

OBJECTIVE The anterolateral thigh flap has recently been rediscovered in Asia as a perforator flap. The objective of this study was to describe the reliability and donor morbidity of the anterolateral thigh flap for head and neck reconstruction without transmuscular perforator dissection. DESIGN Consecutive case series by a single surgeon. SETTING A regional tertiary-referral head, neck, and skull base surgical oncology center. PATIENTS The first 34 consecutive patients. INTERVENTION Microvascular reconstruction with an anterolateral thigh free flap. MAIN OUTCOME MEASURES Primary insufficiency, partial necrosis, complete necrosis, and donor morbidity rates. RESULTS Two flaps necrosed partially (6%). No flaps demonstrated primary insufficiency, necrosed completely, or incurred significant donor morbidity. CONCLUSIONS The anterolateral thigh flap can be reliably harvested without transmuscular perforator dissection and without incurring serious donor morbidity. It possesses workhorse attributes (no repositioning, remote from defect, long pedicle) and is extremely versatile (one is able to independently tailor the skin and muscle), making it ideal for the heterogeneous group of extensive soft tissue head and neck defects. When a forearm flap will likely be too thin or too morbid, the anterolateral thigh flap can be considered its "big brother."