Suprafascial Anterolateral Thigh Flap Harvest: A Better Way to Minimize Donor-Site Morbidity in Head and Neck Reconstruction

Background: The purpose of this study was to compare the clinical outcomes and donor-site morbidity between the suprafascial and subfascial harvesting of anterolateral thigh flaps. Methods: Sixty-one patients who underwent free flap reconstruction (30 suprafascial and 31 subfascial anterolateral thigh flaps) were included in this study. The patients assessed the subjective donor-site morbidity and satisfaction with the overall functional result using a self-reported questionnaire. The flap characteristics (i.e., perforator number, flap size, and harvest time) and outcomes (i.e., success rate, partial necrosis, infection, hematoma, and fistula) were compared. Results: The success rates of suprafascial and subfascial anterolateral thigh flaps were 96.7 and 96.8 percent, respectively. There were no significant differences in flap size, harvest time, or overall complication rates. The suprafascial anterolateral thigh flap group experienced fewer abnormal sensations (p < 0.001) and better subjective satisfaction at the donor site than did the subfascial anterolateral thigh flap group (p = 0.03). Conclusions: In terms of reducing donor-site morbidity, the suprafascial anterolateral thigh flap group showed fewer sensory disturbances in donor thighs and exhibited better patient satisfaction than did the subfascial anterolateral thigh flap group, but meticulous dissection of tiny perforators above the fascia is required for the former procedure.