title: Adipofascial anterolateral thigh flap safety: applications and complications.
abstract: BACKGROUND
  A thinned anterolateral thigh (ALT) flap is often harvested to achieve optimal skin resurfacing. Several techniques have been described to thin an ALT flap including an adipocutaneous flap, an adipofascial flap and delayed debulking.
  
  
  METHODS
  By systematically reviewing all of the available literature in English and French, the present manuscript attempts to identify the common surgical indications, complications and donor site morbidity of the adipofascial variant of the ALT flap. The studies were identified by performing a systematic search on Medline, Ovid, EMBASE, the Cochrane Database of Systematic Reviews, Current Contents, PubMed, Google, and Google Scholar.
  
  
  RESULTS
  The study selection process was adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and 15 articles were identified using the study inclusion criteria. These articles were then reviewed for author name(s), year of publication, flap dimensions and thickness following defatting, perforator type, type of transfer, complications, thinning technique, number of cases with a particular area of application and donor site morbidity.
  
  
  CONCLUSIONS
  The adipofascial variant of the ALT flap provides tissue to fill large defects and improve pliability. Its strong and safe blood supply permits adequate immediate or delayed debulking without vascular complications. The presence of the deep fascia makes it possible to prevent sagging by suspending and fixing the flap for functional reconstructive purposes (e.g., the intraoral cavity). Donor site morbidity is minimal, and thigh deformities can be reduced through immediate direct closure or liposuction and direct closure. A safe blood supply was confirmed by the rate of secondary flap debulking.
authors.affiliation: Maxillofacial Surgery Unit, Hospital of Florence, Florence, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Agostini
authors.forename: Giulia Lo
authors.initials: GL
authors.lastname: Russo
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Zhang
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spinelli
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
keywords: Free flaps; Microsurgery; Systematic review