Medial versus lateral approach to harvesting of anterolateral thigh flap

OBJECTIVE: This study was performed to evaluate two classic procedures guided by anatomic markers for harvesting the anterolateral thigh (ALT) flap: one began with an incision on the lateral side to identify perforators emerging from the muscle to the superficial tissue and to track the perforators upward to the upper stem vessel, and the other began with an incision on the medial side to identify the vessel branch from the stem artery and to track it downward to the flap perforators. METHODS: Twenty-eight consecutive patients with tissue defects repaired with ALT flaps were investigated; 13 and 15 patients underwent the lateral and medial incision technique, respectively. The surgeon’s subjective view regarding procedural difficulty and the operative times were statistically analyzed. RESULTS: All flaps were harvested successfully. A two-paddle flap from one thigh in the medial group failed due to necrosis; all others survived completely. Subjectively, harvesting of flaps starting with a lateral incision was somewhat difficult, and the operative time was significantly longer using the lateral technique. CONCLUSIONS: Classic procedures to harvest the anterolateral thigh flap are still practicable, and starting with a medial incision is more efficient than starting with a lateral incision. Type of study/level of evidence: Therapeutic IV.