title: Achieving direct closure of the anterolateral thigh flap donor site-an algorithmic approach.
abstract: BACKGROUND
  Minimizing donor-site morbidity after free flap harvest is of paramount importance. In this article, we share our experience with achieving primary closure of 58 anterolateral thigh (ALT) free flap donor sites using a simple algorithm in cases where primary closure would otherwise have not been possible.
  
  
  METHODS
  Between 2004 and 2010, 58 patients who underwent free ALT flap reconstruction were included in the study. The inclusion criteria were those who had flap width requirements that were wider than 16% of the thigh circumference and had achieved direct primary closure of the donor site by the use of our technique.
  
  
  RESULTS
  Primary closure of the donor sites was facilitated in all cases by the use of 3 distinct techniques. This included the use of the V-Y advancement technique in 13 patients, split skin paddle technique in 7 patients, and the tubed skin paddle design in 38 patients. No episodes of postoperative wound dehiscence at the donor site were encountered; however, 2 cases were complicated by superficial wound infections that settled with a course of antibiotics.
  
  
  CONCLUSIONS
  Direct primary closure of the ALT donor site can be facilitated by the use of our simple algorithm. Certain strategies need to be adopted at the design stage; however, the techniques used are simple and reliable, produce superior cosmetic results at the donor site, save time, and spare the patient the morbidity associated with the harvest of a skin graft.
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, Kaohsiung, Taiwan; and Division of Plastic Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Jaime Eduardo
authors.initials: JE
authors.lastname: Pachón Suárez
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, Kaohsiung, Taiwan; and Division of Plastic Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Parviz Lionel
authors.initials: PL
authors.lastname: Sadigh
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, Kaohsiung, Taiwan; and Division of Plastic Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Hsiang-Shun
authors.initials: HS
authors.lastname: Shih
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, Kaohsiung, Taiwan; and Division of Plastic Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Ching-Hua
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, Kaohsiung, Taiwan; and Division of Plastic Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Seng Feng
authors.initials: SF
authors.lastname: Jeng