title: Video-assisted harvesting of anterolateral thigh free flap: technique validation and initial results.
abstract: OBJECTIVE
  To provide a description of a minimally invasive, video-assisted technique (VAT) to identify the cutaneous perforators of the anterolateral thigh (ALT). The objective of the study was to compare this technique with standard open exploration of the thigh and to describe the learning curve for the procedure.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic tertiary institution.
  
  
  METHODS
  Twenty-six cases operated between December 2009 and June 2012. In all of these cases, an open thigh exploration, considered the gold standard, was performed immediately after the VAT. Data retrieved included surgical findings, demographics, and outcomes.
  
  
  RESULTS
  There were 17 men and 9 women with a mean age of 60 years. The average flap size was 91 cm(2) (range, 39-264 cm(2)), and a chimeric double skin paddle flap was harvested in 6 cases. Forty-nine of 53 total perforators were successfully identified endoscopically. Findings on endoscopic and open exploration were highly correlated (r = 0.92, P = .000). The overall sensitivity for the technique was 92.4% (confidence interval, 80.9-97.5) but reached 100% for perforators located at the midpoint of the anterior-superior iliac spine-patella line. All flaps survived, and there were no technique-related complications. The learning curve plateaued after 15 cases, with a mean endoscopic operative time of 18.2 minutes for the last 10 procedures.
  
  
  CONCLUSIONS
  This VAT is a safe and reliable method to identify cutaneous perforators of the lateral thigh. The procedure is straightforward and has a moderate learning curve. This approach has a role in minimizing donor site morbidity and assisting in flap design.
authors: Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. mamoreno@uams.edu
authors: Mauricio Alejandro
authors: MA
authors: Moreno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods; D017695:Soft Tissue Injuries / Q000601:surgery*; D013848:Thigh / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000295:instrumentation*
keywords: anterolateral thigh free flap; endoscopic; minimally invasive; perforators; surgical technique; video-assisted