Purpose: Free tissue transfer has revolutionized the skull base surgery by expanding the ability to perform cranial base resection and improving the quality of reconstruction. The rectus abdominis and latissimus dorsi are commonly used flaps for such reconstruction. In this study we present our experience using the anterolateral thigh flap for reconstruction of a variety of cranial-facial defects.

Methods: This study involves a total of 15 patients over 4 years period between 1998, and 2002. Fourteen patients had locally advanced head and neck cancer that required craniofacial resection, and one patient had complicated gunshot wound of the forehead. These patients underwent extensive resection and debridement that resulted in large composite defects. Ten patients were treated at the National Cancer Institute, Egypt, and five patients at University of Miami, Florida. All patients were immediately reconstructed using the anterolateral thigh free flap. A two-team approach was applied for all patients. The success rate, recipient vessels used, donor site morbidity, and complications were examined.

Results: The anterolateral thigh flap was used to reconstruct a variety of extensive cranial-facial defects. These defects consisted of composite scalp and calvarium (3), anterior skull base (4), lateral skull base (3), and composite midface defects (5). The free flap was successful in 14 patients. One patient developed complete flap necrosis. Five patients received preoperative radiation therapy. One patient died one month postoperatively from pulmonary embolism. The most commonly recipient vessels were the facial vessels and the external jugular vein. The average length of the vascular pedicle was 12 cm. Skin perforators were presented in a musculocutaneous pattern in most of the cases (13/15). There was no CSF leak. Three patients developed partial wound deheisnce. The donor site was closed primarily in 10 patients. Donor site morbidity included partial loss of the skin graft in two patients, and wound infection and superficial sloughing in one patient.

Conclusion: The anterolateral thigh free flap is a versatile flap for head and neck reconstruction. It is a reasonable option for skull base reconstruction. It has the advantages of allowing comfortable two-team approach, providing generous amount tissue without jeopardizing the integrity of the abdominal wall and less pain and atalectasis postoperatively.