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

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Abstract

Objectives

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.

Methods

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.

Results

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.

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Author information

Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia

    Ross K. Smith & Navin Niles

  2. Department of Head and Neck Surgery, Liverpool Hospital, Liverpool, NSW, Australia

    James Wykes & Navin Niles

  3. College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia

    David T. Martin

  4. Department of Surgery, Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia

    Ross K. Smith

Authors
  1. Ross K. Smith
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  2. James Wykes
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  3. David T. Martin
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  4. Navin Niles
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Correspondence to Ross K. Smith.

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Smith, R.K., Wykes, J., Martin, D.T. et al. Perforator variability in the anterolateral thigh free flap: a systematic review. Surg Radiol Anat 39, 779–789 (2017). https://doi.org/10.1007/s00276-016-1802-y

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  • DOI: https://doi.org/10.1007/s00276-016-1802-y

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