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Background: Anterolateral thigh flap (ALTF) even though has been around since 1984 when it was first described by Song et al. did not enjoy the wide acceptance as its other contemporary free flaps received in the reconstructive surgeries. The main reason being the anatomic variations in its vascular pedicle and bulky nature. This study aims to evaluate the anatomic variations, technical details and to elucidate the plethora of clinical applications of free ALTF in the reconstruction of head and neck malignancy defects. Materials and Methods: A total of 20 patients who underwent reconstruction of post malignancy defects in the head and neck region in the Department of Oral and Maxillofacial Surgery, SDM College of Dental Sciences, Dharwad, India, were included in this study. Their records were analyzed to evaluate the technical details, vascular pedicle, clinical applications, and the associated complications. The patients were followed up for not <1-year postoperatively. Results: All the ALTF in our study had skin perforators with the majority being musculocutaneous. There were no flap failures and the flaps were used to reconstruct different composite defects successfully with least complication rates. Conclusion: ALTF meets most of the requirements of reconstructive surgeons as it can provide a large skin paddle which is fed by a long and wide caliber pedicle. The flap finds its appeal in minimal donor site morbidity and can be harvested by a two team approach. The disadvantages of anatomic variations can be negated by Doppler mapping and retrograde perforator dissection.

Anatomic Variations, Technique, and Clinical Applications of Anterolateral Thigh Flap for the Reconstruction of Head and Neck Defects