Anterolateral thigh flap reconstruction of large external facial skin defects: a follow-up study on functional and aesthetic recipient- and donor-site outcome

Abstract

Background: The purpose of this study was to investigate the subjective and the objective functional and aesthetic follow-up results of the recipient and donor sites after reconstruction of extensive facial defects with the anterolateral thigh flap.

Methods: Between December of 2001 and April of 2003, the anterolateral thigh flap was used to reconstruct large facial skin defects after malignant tumor resection in 23 white patients. All patients had a standardized interview, physical examination, and clinical photographs.

Results: The mean flap size was 108 cm2. Fasciocutaneous anterolateral thigh flaps were used in 15 patients and musculocutaneous flaps were used in eight patients with exposed dura, open sinuses, or orbital defects. An extra free osteocutaneous fibula flap was necessary to reconstruct the affected mandible in 10 patients. The donor site was skin grafted in 18 patients. The flap survival rate was 96 percent. At follow-up, color mismatch (71 percent) and flap bulkiness (50 percent) were encountered most often. Four of five patients with speech problems had received an additional free osteocutaneous fibula flap. Three flap contractures were seen in the neck region. A contour defect of the upper leg was encountered in five patients. Sensory disturbances of the upper leg were observed in 12 patients. Cold intolerance occurred three times after skin grafting. No significant impairment was found in range of motion and muscle strength of the donor leg.

Conclusions: Careful patient selection may further improve aesthetic outcome of the anterolateral thigh flap. The versatility in design and composition of the anterolateral thigh flap and the low donor-site morbidity and satisfactory recipient-site outcome make it a valuable option in reconstruction of external skin defects in the head and neck region.