Surgical and Radiologic Anatomy

, Volume 39, Issue 7, pp 779–789 | Cite as

Perforator variability in the anterolateral thigh free flap: a systematic review

  • Ross K. SmithEmail author
  • James Wykes
  • David T. Martin
  • Navin Niles



The use of free flaps greatly improves reconstruction options and quality of life for patients undergoing oncological resections. The anterolateral thigh (ALT) free flap is frequently used in the head and neck. The aim of this review was to provide a summary of published evidence assessing perforator anatomy of this flap.


A broad search was undertaken through the PubMed database using the terms “anterolateral thigh free flap” and “perforator”. Search limits included English language and human subjects. Studies that examined more than or equal to ten patients were analysed.


A total of 23 studies were identified, which included both clinical and cadaver studies. 1251 thighs were examined with the mean number of perforators ranging from 1.15 to 4.26. In the majority of cases, the descending branch of the lateral circumflex femoral artery was the dominant pedicle and took a musculocutaneous route. In some series, up to 5.4% of thighs were identified as having no cutaneous perforators. Venous data is limited with most studies reporting the presence of two concomitant veins of which the largest concomitant vein is selected for venous anastomoses.

Conclusions and future studies

The ALT free flap is a reconstruction option in head and neck cancer. Adequate perforators for reconstruction are identified in the majority of cases. Increased anatomical perforator knowledge may lead to further uptake of ALT free flap reconstruction and improved intraoperative troubleshooting. Further studies investigating those patients with no perforators in the ALT may lead to improved clinical outcomes.


Anterolateral thigh Free flap Perforator 


Compliance with ethical standards

Conflict of interest

The authors report no conflicts.

Supplementary material

276_2016_1802_MOESM1_ESM.docx (84 kb)
Supplementary material 1 (DOCX 83 KB)


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Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  • Ross K. Smith
    • 1
    • 4
    Email author
  • James Wykes
    • 2
  • David T. Martin
    • 3
  • Navin Niles
    • 1
    • 2
  1. 1.Faculty of Medicine and Health SciencesMacquarie UniversitySydneyAustralia
  2. 2.Department of Head and Neck SurgeryLiverpool HospitalLiverpoolAustralia
  3. 3.College of Medicine and DentistryJames Cook UniversityTownsvilleAustralia
  4. 4.Department of SurgeryCairns HospitalCairnsAustralia

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