Rationale for Reconstruction of Large Scalp Defects Using the Anterolateral Thigh Flap: Structural and Aesthetic Outcomes

The advent of free tissue transfer has provided multiple options that allow the preservation and maintenance of both the structural and aesthetic status of the scalp. Since the first report of the anterolateral thigh flap in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft tissue defects.

Eleven free anterolateral thigh flaps were used to reconstruct soft tissue defects of different regions of the scalp. Two of these flaps were used for the occipital region, 6 for the temporal region, 2 for the frontoparietal midline region, and the remaining flap was used for a defect of the forehead. The study consisted of 10 male and 1 female patients whose ages ranged from 18 to 82 years (mean age 52.5 years). Six patients had primary or recurrent cancer, 4 patients had acute or subacute wounds resulting from trauma or craniotomy, and 1 patient had high–tension electrical burn injury. The size of the flaps ranged from 14 to 27 cm in length and from 6 to 18 cm in width.

The overall flap success rate was 100%. In 2 cases, primary thinning of the flap was performed to reconstruct a tissue defect of the temporal region in 1 patient and a forehead defect in the other. In 2 patients, the fascial layer of the flap was used to cover defects of the dura mater as a source of vascularized fascial flap. No secondary corrections, including debulking procedure or scar revision, were necessary. No infections or hematomas were observed. Six cases underwent split- thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed directly. No donor site morbidity was observed.

The authors concluded that, with its evident structural and cosmetic advantages, the anterolateral thigh flap can be considered an excellent and ideal flap option for most scalp defects.