The versatility of the anterolateral thigh/vastus lateralis flap Applications, nervous reanimation

The anterolateral thigh flap (ALT) has been established as a recognized versatile workhorse in plastic reconstructive surgery worldwide for many years. Due to the variable vascular anatomy, however, there are still concerns, especially for head and neck reconstructions. This article emphasizes anatomical specifics of this extraordinarily variable flap and is intended to facilitate the entry of interested colleagues by providing practical advice on key steps in flap harvesting. The finding of suitable, usually musculocutaneous perforators and the careful dissection of these sensitive vessels are often key to success. A certain learning curve is indispensable when raising this flap compared to, for example, the radial forearm flap. Overall, there is currently no comparable graft in our field that is able to reliably reconstruct different tissue types, shapes, and volumes, possibly with motor nerve or sensory innervation, in such a versatile way.