"Vascular preparation first": A valuable strategy in anterolateral thigh flap harvest

The anterolateral thigh flap is one of the most popular flaps in reconstructive surgery today. Versatility and minimal donor site morbidity are the distinct advantages of using this flap. However, possible anatomic variations in perforators or source vessels may present a challenge to the novice surgeons and those who are not familiar with the flap anatomy. These challenges may compromise flap reliability and undermine surgeon's confidence. Therefore, to allow surgeons, especially in their first ALTs, to harvest a reliable ALT nomatter how challenging the anatomy is, the authors propose a stepwise strategy that is reproducible and safe. As a result, the proposed approach of identifying available skin vessels first, addressing source vessels second, and revealing the origin and the course of skin vessels and source vessels third will simplify ALT flap harvest and allow flexibility in design.