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Use of the Myocutaneous ALT in Head and Neck Reconstructions: A Review of 137 Consecutive Cases
Ian Valerio MD, MS, MBA1, Sajel Patel MD2, Jason Prigozen MD3, Ming-Heui Cheng MD, MHA4
Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
2010-03-29
Presenter: Jason Prigozen
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: The anterolateral thigh flap (ALT) has become an established workhorse flap for many reconstructive endeavors. The vascular variability of the flap, however, adds complexity to the harvest, thus limiting the widespread acceptance of this flap. In this paper, the authors will review the use of myocutaneous ALT free flaps in various head and neck reconstructions as well as provide a new algorithm in the salvage of the fasciocutaneous ALT flap with abnormal or compromised vasculature patterns.
Methods: A single center prospective consecutive series of function preserving, muscle sparing, myocutaneous ALT flaps used in head and neck reconstruction at Chang Gung Memorial Hospital, Linkou was reviewed. Defect types, locations, and complications were analyzed.
Results:
A total of 320 ALT flaps (183 fasciocutaneous, 137 myocutaneous) were utilized to reconstruct head and neck defects. Of the 137 myocutaneous ALT flaps, the following number and percentages of defects were reconstructed: Complex composite defects 46 (34%), buccal 32 (23%), tongue 26 (19%), pharyngeal 16 (12%), retromolar 11 (8%), and cranial 6 (4%), respectively. Total flap failure (3%) and partial flap failure (1.5%) were comparable in both fasciocutaneous and myocutaneous ALT cases, respectively.
Conclusion: This review critically assessed use of myocutaneous ALT flaps in head and neck reconstruction. Additionally, the authors have described a technique to convert fasciocutaneous ALT flaps with inadequate perforators into function preserving, muscle sparing, myocutaneous ALT flaps in an effort to expand upon the salvage algorithm of ALT flaps having abnormal vascular variability or anatomy.
