The perforator from the lateral femoral circumflex artery8,9.

Theconcept of septocutaneous artery flaps is well established, though they may beconsidered as one variety of fasciocutaneous flap (Cormack and Lamberty, 1984).1Septocutaneous flaps from the arm and thigh have advantages over some othertypes of flap and have been widely used for the reconstruction of variousdefects (Song et al, 1982a&b2,3; Baek, 19834; Song et al, 19845).Among these septocutaneous artery flaps, the Anterolateral thigh flap (ALT)which was first reported by Song etal.

(1984)5 which became the workhorse for the head and neckreconstruction.As technology and knowledge of the flap evolved,it was evident that perforators were the dominant source of blood supply ratherthan a random pattern of supply. The ALT flap is based on a cutaneousperforator that usually originates from the descending branch of the lateralfemoral circumflex artery. The main perforator is usually traced on the midportion of the line drawn between the anterior superior iliac spine and superolateralborder of the patella of the donor thigh6,7. Many studies haveproven that the ALT flap can be safely extended to include adjacent vascularterritories perfused by a single perforator from the lateral femoral circumflexartery8,9. Since thattime, it has seen broad application in extremity, trunk, abdomen, as well ashead and neck reconstruction6.

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The use of the ALT flap, either as a free or pedicle flap, hasbeen extensively reported in reconstruction of soft tissue defects from head totoe 10,11; hence in 2002, Wei et al. defined it as the ideal softtissue flap6.Its anatomy has been widely studied and its clinicalapplication is favoured for a number of reasons including tremendousversatility, consistent long vascular pedicle, adequate vessel caliber, largeflap territory, minor donor site morbidity, ease to design, and possibility toenhance a two-team approach.

12,13,14 The thickness of the flap isalso adaptable.15 Dependingupon the thickness requirements of the recipient site, the ALT can be adaptedto include skin only, skin and varying amounts of subcutaneous adipose tissue,or skin, subcutaneous tissue and muscle6. The flap can be harvestedas a fasciocutaneous flap via subfascial dissection6, cutaneous flapvia suprafascial dissection16,17, musculocutaneous flap incombination with vastus lateralis or rectus femoris muscle6 ,adipofascial flap with no skin paddle18 , with vascularized nerve19  or innervated muscle20,21 , withtensor fascia lata22 or as a sensate flap23  to provide the necessary reconstructivetissue components.

The ability to harvest chimeric flaps (i.e. multipleindependent flap territories each with an independent vascular supply, nophysical connection and a common source vessel24) also contributesto the utility of the ALT free flap for head and neck reconstruction6.

Furthermore, it is possible to use it as a sensate orflow-through flap if necessary.25 The ALT flap gained great popularity in mainland China, Taiwan,and Japan based on its versatility, the two-team approach and low donor-sitemorbidity. However, due to several variations in the vascular anatomy of theperforators, the ALT flap has not been met with the same enthusiasm in ourcountry.Herein, we review the ALT flap with special attention fromidentification of perforator to the complete harvest of the flap and to thespecific complications.

The present manuscript attempts to identify the commonsurgical indications, intraoperative findings, complications, and donor sitemorbidity of the ALT flap.