title: Anterolateral thigh myocutaneous flaps as the preferred flaps for reconstruction of oral and maxillofacial defects.
abstract: BACKGROUND
  The anterolateral thigh myocutaneous flap is one of the most commonly used flaps in reconstructive procedures, but its application in oral and maxillofacial defects has not been fully determined. Herein, we summarize the application of 1212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects and examine their benefits in maxillofacial reconstruction of these defects.
  
  
  METHODS
  Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Patient ages ranged from 6 to 82 years with a mean age of 51.2 years. There are 1015 flaps showing single lobe and 197 flaps showing a multi-island pedicle and one of which carries the iliac bone. The largest area among the single flaps was 28 × 12 cm(2), and the smallest was 3 × 2 cm(2).
  
  
  RESULTS
  Among the 1212 transferred flaps, 1176 survived and 36 showed necrosis, a survival rate of about 97.0%. The common complications at flap donor site were poor wound healing (10.1%), localized paraesthesia (50.1%), and altered quadriceps force (11.0%). No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time (23-121 min; average 51 min) for anastomosis of one vein and one artery was significantly less than that for two veins and one artery (45-153 min, average 83 min; p = 0.0003), which indicates one vein anastomosis can significantly reduce the operating time.
  
  
  CONCLUSIONS
  The anterolateral thigh myocutaneous flaps can be easily obtained and can provide a good amount of muscle for filling dead space and fascia lata. These flaps can be prepared into a separate fat flap, multi-island fascia with iliac bone, and other composite pedicle flaps to meet the various requirements of oral and maxillofacial defects. The subcutaneous fat thickness of the anterolateral area can vary considerably and thus can be used to repair defects requiring different flap thickness. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China. Electronic address: shangyuanpan@gmail.com.
authors.forename: Zhen-Hu
authors.initials: ZH
authors.lastname: Ren
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China. Electronic address: wuhanjiang0198@sina.com.
authors.forename: Han-Jiang
authors.initials: HJ
authors.lastname: Wu
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China.
authors.forename: Hong Yu
authors.initials: HY
authors.lastname: Tan
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, Hunan 410011, China.
authors.forename: Zhao Jian
authors.initials: ZJ
authors.lastname: Gong
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D005206:Fascia Lata / Q000637:transplantation; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D009336:Necrosis; D061646:Operative Time; D019647:Oral Surgical Procedures / Q000379:methods*; D010292:Paresthesia / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000637:transplantation; D013848:Thigh / Q000601:surgery; D060053:Transplant Donor Site / Q000601:surgery; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: Anterolateral thigh myocutaneous flap; Oral and maxillofacial defects; Oral cancer; Reconstruction