Anterolateral Thigh Flap Applications in Soft Tissue Reconstruction

The anterolateral thigh (ALT) flap has established itself as a versatile workhorse in reconstructive surgery, offering a reliable fasciocutaneous or myocutaneous tissue source with consistent vascular anatomy. Based on perforators of the lateral circumflex femoral artery, the ALT flap can be tailored in size, thickness and composition to address diverse soft tissue defects. Modifications include lobulated perforator designs for irregular limb wounds, multipaddled chimeric flaps for complex head and neck reconstructions, extended or thinned variants for foot, ankle and extremity coverage, and flow-through constructs to restore both soft tissue and vascular continuity. Advances in imaging and digital planning have further refined flap harvest, enabling precise mapping of perforators, virtual three-dimensional modelling and patient-specific guide fabrication. Global experience demonstrates favourable outcomes in oncological, traumatic and infectious settings, with low donor-site morbidity and high rates of flap survival. The capacity to combine skin, fascia, muscle or adipose components in a single vascular pedicle underpins the ALT flap’s continuing evolution, supporting both functional restoration and aesthetic refinement across a broad spectrum of clinical indications.

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Anterolateral Thigh Flap Applications in Soft Tissue Reconstruction publication trend

The graph below shows the total number of articles in anterolateral thigh flap applications in soft tissue reconstruction across all publications each year (not limited to Nature Index journals).

Technical terms

Anterolateral thigh flap (ALT flap): fasciocutaneous or myocutaneous tissue harvested from the lateral thigh based on perforators of the lateral circumflex femoral artery.

Perforator flap: a flap comprising skin and subcutaneous tissue supplied by a single vascular perforator passing through muscle or septum.

Lobulated perforator flap: a flap design incorporating multiple skin paddles based on separate perforators from the same vascular source.

Computed tomography angiography (CTA): a radiological technique that visualises blood vessels using contrast-enhanced CT imaging.

Augmented reality (AR): technology overlaying digital images onto the surgical field to guide perforator mapping and flap harvest.

3D-printing guide: a custom-fabricated template based on imaging data to assist precise surgical marking and dissection.

References

1. Clinical application of digital technology in the use of anterolateral thigh lobulated perforator flaps to repair complex soft tissue defects of the limbs. Burns & Trauma (2024).
2. Multipaddled Anterolateral Thigh Chimeric Flap for Reconstruction of Complex Defects in Head and Neck. PLOS ONE (2014).
3. Extended Anterolateral Thigh Flaps for Reconstruction of Extensive Defects of the Foot and Ankle. PLOS ONE (2013).
4. Augmented reality-assisted systematic mapping of anterolateral thigh perforators. BMC Musculoskeletal Disorders (2022).
5. Anterolateral thigh perforator flap made by customized 3D-printing fabrication of fixed positioning guide for oromaxillofacial reconstruction: a preliminary study. Medicina Oral Patología Oral y Cirugia Bucal (2023).