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A Prospective Study of Donor-Site Morbidity after Anterolateral Thigh Fasciocutaneous and Myocutaneous Free Flap Harvest in 220 Patients

Hanasono, Matthew M. M.D.; Skoracki, Roman J. M.D.; Yu, Peirong M.D.

Plastic and Reconstructive Surgery: January 2010 - Volume 125 - Issue 1 - p 209-214
doi: 10.1097/PRS.0b013e3181c495ed
Reconstructive: Lower Extremity: Original Articles

Background: The anterolateral thigh free flap may be harvested as a fasciocutaneous perforator flap or as a myocutaneous flap by including variable amounts of the vastus lateralis muscle. The authors sought to determine the donor-site morbidity associated with both types of flap dissection.

Methods: Between 2005 and 2008, the authors performed 220 reconstructive operations using the anterolateral thigh free flap. Complications and donor-site function were evaluated prospectively.

Results: Variable amounts of vastus lateralis muscle were harvested with the flap in this series: 25 percent included no muscle, 38 percent included minimal muscle, 33 percent included the superficial half of the muscle, and 4 percent included the entire muscle. The motor nerve to the vastus lateralis muscle was spared during dissection of the flap pedicle in 78 percent but required division in 22 percent. Complications included seroma (5 percent), wound dehiscence (2 percent), hematoma (1 percent), infection (1 percent), neuroma (1 percent), and partial skin graft loss (1 percent). Eighty-four percent of patients reported a sensory loss in the distribution of the lateral femoral cutaneous nerve. Weakness or instability was reported by 8 percent of patients at their initial postoperative visit but resolved in all patients within 6 months. All patients regained their postoperative level of activity.

Conclusions: The anterolateral thigh free flap is associated with a low rate of complications and functional morbidity. Even when the motor nerve to the vastus lateralis is divided, or substantial amounts of thigh fascia or vastus lateralis muscle are included in the flap design, all patients return to their preoperative level of function.

Houston, Texas

From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.

Received for publication June 14, 2009; accepted August 11, 2009.

Presented at the 23rd Annual Meeting of the American Society for Reconstructive Microsurgery, in Maui, Hawaii, January 10 through 13, 2009.

Disclosures: None of the authors has any commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article.

Matthew M. Hanasono, M.D., Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 443, Houston, Texas 77030,

©2010American Society of Plastic Surgeons