Alternative reconstructive choices for anterolateral thigh flap dissection in cases in which no sizable skin perforator is available

Background. Alternative choices were proposed to facilitate a successful reconstruction when no sizable skin perforator is encountered in anterolateral thigh (ALT) flap dissection. Methods. Alternative choices such as harvest of a tensor fascia latae (TFL) flap, elevation of an anteromedial thigh (AMT) flap, use of a free muscle component with full-thickness skin graft coverage, and use of another donor flap were performed. Results. Between August 1995 and December 2006, 10 of 923 patients underwent ALT flap elevation with no sizable perforators. Of them, each of the 4 patients received reconstruction with a free TFL flap, 3 with an AMT flap, 2 with a free muscle flap, and 1 with a radial forearm flap. There was 1 TFL flap failure due to postoperative venous thrombosis, and the defect was repaired by an AMT flap. Conclusion. When no sizable perforator is encountered, successful reconstruction could still be achieved by the proposed alternative choices.