title: The Anterolateral Thigh Flap as the Flap of Choice for Scalp Reconstruction.
abstract: BACKGROUND
  Large scalp soft tissue defects can present difficulties with reconstruction. The ideal flap for scalp reconstruction has yet to be described although the latissimus dorsi flap is frequently referred to as the first choice in this setting.
  
  
  METHODS
  Following institutional review board approval, the authors reviewed their experience in scalp reconstruction for the past 4 years. Patient demographics, reconstruction indication, flap choice, complications, and outcomes were recorded.
  
  
  RESULTS
  Thirteen patients underwent scalp reconstruction with an anterolateral thigh (ALT) free flap. In most patients, the indication was resection of a cutaneous malignancy. In all but 1 patient the facial or more proximal vessels were used for anastomosis. None of the patients required vein grafts to increase pedicle length. The median flap surface area was 156 cm. One flap had vascular compromise. All donor sites healed without complications.
  
  
  CONCLUSIONS
  The ALT flap can emerge as the flap of choice for scalp reconstruction, even when proximal neck vessels are used as the recipient targets. Using a suprafascial dissection and extending the vascular pedicle to the profunda femoris artery can optimize its role in this setting. The ALT flap provides excellent cosmesis and durable scalp coverage with minimal donor site morbidity.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Lamaris
authors.forename: Rebecca
authors.initials: R
authors.lastname: Knackstedt
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Couto
authors.forename: Nasim
authors.initials: N
authors.lastname: Abedi
authors.forename: Paul
authors.initials: P
authors.lastname: Durand
authors.forename: Brian
authors.initials: B
authors.lastname: Gastman
mesh_terms: D005263:Femoral Artery; D058752:Free Tissue Flaps / Q000098:blood supply; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D009333:Neck / Q000098:blood supply; D019651:Plastic Surgery Procedures / Q000379:methods; D012535:Scalp / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery; D013848:Thigh / Q000601:surgery