Purpose The anterolateral thigh flap is versatile and useful to reconstruct various types of defects. To repair the defects that need a thin and pliable gliding coverage, we developed the anterolateral thigh adipofascial perforator flap from the anterolateral thigh region, which utilized the vascularized adipofascial layer, rather than the conventional skin portion, of the conventional anterolateral thigh flap.

Patients and Methods We report eleven cases in which this flap was used for the reconstruction of the extremity defects successfully from 1999 to 2002. Six patients had lower limb defects resulting from crushing injuries, three patients had finger defects caused by degloving injuries, one patient had the wrist volar defect after a burn injury, and one diabetic patient had a pretibial chronic ulcer with tendon exposure. There were six males and five females with age ranging from 20 to 71 years. Only the deep fascia of anterolateral thigh and 2 to 3 mm thickness subcutaneous fatty tissue above the fascia was harvested as a free perforator flap for the extremities reconstruction. Immediate or delay split-thickness skin graft was used for flap resurfacing, and the donor site was closed directly.

Results The flaps ranged in size from 5 to 11 cm in length and 4 to 8 cm in width. A flap dimension as large as 8*22 cm2 in area could be harvested successfully. Immediate split-thickness skin grafts were used to resurface these adipofascial flaps in eight patients; in another three patients, delayed skin grafts were done about one week after flap reconstruction. Bleeding from the edge of deep fascia layer and its adipose surface and subsequent successful skin grafts take confirmed the viability of the adipofascial flap. All the donor sites were closed directly with minimal morbidity.

Conclusions The virtue of the anterolateral thigh adipofascial flap is its ability to provide a vascularized, thin, pliable and gliding coverage and the donor defect can be closed directly with less noticeable scar and minimized donor site morbidity. Safe elevation, a long and wide vascular pedicle, and being a flow through pattern to reconstruct major vessel defect simultaneously is also its advantages. This adipofascial flap had another advantage than the fascial flap as minimizing the flap surface break down by providing a subcutaneous fat to cushion the skin graft. The main disadvantages include the need of skin graft with its possible subsequent skin graft loss or hyperpigmentation and the difficulty of postoperative flap monitor.