title: Selection of ideal perforators and the use of a free-style free flap during dissection of an anterolateral thigh flap for reconstruction in the head and neck.
abstract: The technique of raising an anterolateral thigh (ALT) perforator flap has been revolutionised by free-style retrograde intramuscular dissection of perforators to overcome anatomical variations, but choosing the appropriate perforator is still the key to success. We have shown this in a 41-year-old man with cancer of the buccal mucosa treated by wide excision and reconstruction with an ALT free flap that failed because of formation of microthrombi within the perforator. We identified only one tiny perforator that followed an 8cm, tortuous course within the vastus lateralis muscle. A long, narrow lumen in the perforator increases resistance proportionally to the length and four times the radius. Difficult dissection of the root makes the vessels prone to spasm. If no sizeable perforator is found, adjacent tissues on the medial or proximal thigh could be raised as alternative free-style flaps.
authors.affiliation: Aesthetic Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: changcc1975@gmail.com.
authors.forename: Chang-Cheng
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. Electronic address: royjhs@gmail.com.
authors.forename: Jen-Hsiang
authors.initials: JH
authors.lastname: Shen
authors.affiliation: Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong. Electronic address: karenchan0510@gmail.com.
authors.forename: Karen Kar-Wun
authors.initials: KK
authors.lastname: Chan
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: fcw2007@cgmh.org.tw.
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
mesh_terms: D000328:Adult; D058752:Free Tissue Flaps; D006257:Head; D006801:Humans; D008297:Male; D009062:Mouth Neoplasms / Q000601:surgery*; D061525:Perforator Flap; D019651:Plastic Surgery Procedures; D013848:Thigh
keywords: Anterolateral thigh flap; Free-style free flap; Perforator