Extended Anterolateral Thigh Flaps: Maximum Size for Covering Cancerous Defects.

Background: The anterolateral thigh perforator flap is frequently used for massive soft-tissue defect reconstruction. Cadaver perfusion examinations of isolated anterolateral thigh flaps have suggested a maximum skin area that may be vascularized based on the perforating vessels (ie, 250 cm 2 ). Therefore, this study aimed to evaluate a series of consecutive cases involving use of extended anterolateral thigh flaps for oncologic reconstruction of massive soft-tissue defects. To our knowledge, this is the largest study of extended anterolateral thigh flaps at a single center.

Methods: Patients who underwent transfers of anterolateral thigh flaps exceeding 250 cm 2 at our institution between April 2018 and December 2022 were retrospectively identified. The operative data and results were analyzed.

Results: Thirty-eight flaps in 36 cases were included. The 38 flaps consisted of 31 free flaps and 7 pedicled flaps. The average skin paddle size was 363 ± 101 cm 2 (range, 250-660 cm 2 ). The donor site was primarily closed in 7 flaps. The remaining 31 flaps required skin grafting to ensure donor-site closure. Neither total nor partial flap loss was observed. Four patients had wound dehiscence due to tightness. Three patients had surgical-site infections. Two patients had seromas. The postoperative courses of the 5 patients were complicated by partial skin graft loss at the donor sites.

Conclusions: The anterolateral thigh flap is versatile and reliable for the treatment of massive oncological defects. Even flaps much larger than 250 cm 2 can usually be harvested safely based on 2 to 4 perforators without special techniques, such as compound flaps or additional vessel anastomoses.