Various surgical techniques to create an aesthetic appearance at the donor site of anterolateral thigh free flaps based on the oblique branch: Twenty-one clinical case reports

RATIONALE: Reducing the morbidity associated with anterolateral thigh (ALT) donor sites by performing aesthetic restoration has become a popular research topic. Various surgical techniques have been developed allowing for direct closure of the donor site. However, closure techniques for ALT donor sites based on the oblique branch have not been systematically reported. PATIENT CONCERNS: Data from 21 patients (18 males, 3 females) undergoing operative reconstruction with an ALT free flap between January 2016 and December 2016. The mean age of the participants was 42 years (range, 18–60 years). DIAGNOSES: The soft-tissue defects resulted from a traffic accident in 9 patients, a fall injury in 7 patients, a machinery injury in 3 patients, an electrical injury in 1 patient, and a burn scar in 1 patient. The wound areas ranged from 6 × 3.5 to 28 cm × 10 cm. INTERVENTIONS: Several surgical techniques, including the split skin paddle technique and utilization of an adjacent perforator flap or an ipsilateral groin flap, were utilized to facilitate direct closure of the ALT flap donor site. OUTCOMES: Of the 21 patients included in the study, the donor sites were directly sutured in 14 patients (8 of which required a split skin paddle technique). Four patients required an adjacent perforator flap, and 3 patients received an ipsilateral groin flap. The size of the adjacent perforator flaps ranged from 15 × 5 to 17 × 6 cm. The groin flaps ranged from 18 × 6 to 28 × 6 cm. All the flaps had excellent appearance and texture. A linear scar in the donor area was not conspicuous and achieved an aesthetic appearance. LESSONS: The ALT flap donor site based on the oblique branch pedicle can be directly closed without skin grafts through the use of several surgical techniques.