title: The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: one surgeon's experience in 92 cases.
abstract: BACKGROUND
  Applications of the free anterolateral thigh (ALT) musculocutaneous flap have been largely underestimated compared with indications for fasciocutaneous or perforator flaps. In this article, the authors critically review the experience of a single surgeon with the free ALT musculocutaneous flap for head and neck reconstruction, focusing on its applications in different cephalic areas and on advantages and disadvantages of this technique.
  
  
  METHODS
  Ninety-two patients were treated using a free ALT musculocutaneous flap. Reconstructed areas included tongue, oropharynx, mandible, maxilla, hypopharynx, cheek, and skull base.
  
  
  RESULTS
  Flap survival rate was 97.8%. Donor site morbidity consisted in two cases of partial necrosis of the skin graft used its closure with a final donor site complication rate of 2.2%. Overall results showed an 89% of patients returned to a normal or a soft diet. Speech was good or intelligible in 88% and cosmesis resulted good or acceptable in 89% of cases.
  
  
  CONCLUSIONS
  The free ALT musculocutaneous flap offers unique advantages in head and neck reconstructions including adequate bulk when needed, obliteration of dead space, support for the soft tissues of the face, low donor-site morbidity, and harvesting without needing for perforators dissection, allowing for optimal patient outcome. Excessive bulky and thickness of subcutaneous tissue, especially in occidental population, have to be considered as the main disadvantages of this technique, finally the high incidence of hairy skin in thigh area in male patients and donor site scars associated with the use of skin grafts have to be considered as supplementary minor drawbacks.
authors.affiliation: Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italia.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Bianchi
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferri
authors.forename: Silvano
authors.initials: S
authors.lastname: Ferrari
authors.forename: Chiara
authors.initials: C
authors.lastname: Copelli
authors.forename: Pietro
authors.initials: P
authors.lastname: Boni
authors.forename: Teore
authors.initials: T
authors.lastname: Ferri
authors.forename: Enrico
authors.initials: E
authors.lastname: Sesenna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D058752:Free Tissue Flaps; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D037981:Neck Dissection; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D013848:Thigh / Q000601:surgery; D020858:Tissue and Organ Harvesting; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult