Head and neck reconstruction with anterolateral thigh flap ANTTI A. MA ¨ KITIE, MD, PHD, NIGEL J. P. BEASLEY, MB, PETER C. NELIGAN, MB, JOAN LIPA, MD, PATRICK J. GULLANE, MB, and RALPH W. GILBERT, MD, Toronto, Ontario, Canada OBJECTIVE: Our goal was to present our experience with the free anterolateral thigh flap for reconstruc- tion of various cutaneous and mucosal defects of the head and neck. STUDY DESIGN: We conducted a retrospective re- view of 37 patients who underwent reconstruction between 1994 and 2002. Outcome measures in- cluded ethnicity, flap harvest technique, vascular anatomy, flap success, general surgical complica- tions, and donor site morbidity. RESULTS: The majority of our patients were white (n  33). The size of the 39 free anterolateral thigh flaps varied from 24 to 252 cm 2 . There was 1 arterial failure and flap loss (2.6%) and 2 venous occlusions that were both salvaged. The donor site was closed primarily in 37 cases and with a split-thickness skin graft in 2 cases. CONCLUSIONS: This is the first report on using the free anterolateral thigh flap in whites. This free trans- fer has proved to be a versatile and reliable flap for reconstruction of the head and neck. (Otolaryngol Head Neck Surg 2003;129:547-55.) T he anterolateral thigh flap is a fasciocutaneous flap based on the musculocutaneous and septocu- taneous perforators of the descending branch of the lateral circumflex femoral artery and its venae commitantes. This flap’s surgical anatomy and clinical use were first reported by Song in 1984. 1 In 1993 Koshima et al 2 described its use in the Japanese population, and numerous subsequent re- ports have described its successful use in head and neck reconstruction in the Asian population. 3-6 This flap has some significant advantages for reconstruction of the head and neck. It can be raised as a subcutaneous flap, a fasciocutaneous flap, or a myocutaneous flap and can resurface large defects in the head and neck. In addition, it has a large and long vascular pedicle, and because of the distance of the donor site from the head and neck, it can easily be harvested with a 2-team approach. This flap has not gained widespread use in North America largely because the dissection of this flap may be technically difficult due to vary- ing anatomy of the perforating branches of the descending branch of the lateral circumflex fem- oral artery. 3,7 In addition, the lateral thigh donor site in many white North American patients is considerably thicker than that of the Asian popu- lation due to the differential body habitus and incidence of obesity in this population. The purpose of this study was to report our surgical experience with the use of the anterolat- eral thigh flap in head and neck reconstruction in a white population. This is the first report to de- scribe the results of the use of the anterolateral thigh free tissue transfer in a North American population. METHODS We reviewed the records of 37 consecutive pa- tients undergoing 39 anterolateral thigh free tissue transfers for head and neck cancer surgery defects between 1994 and 2002 at the University Health Network, Toronto, Ontario. Details were collected on the patients’ age, gender, ethnicity, pathology of the neoplasm, previous treatment, and comor- bidities. The site of reconstruction, flap-harvesting technique, recipient vessels used, flap-related complications, general surgical complications, do- nor site morbidity, and operative time were noted. Flap Anatomy The anterolateral thigh flap is supplied by per- forating vessels arising from the descending branch of the lateral circumflex femoral artery. From the Wharton Head and Neck Centre, Princess Margaret Hospital, University Health Network. Presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, San Diego, CA, September 22-25, 2002. Reprint requests: Ralph W. Gilbert, MD, FRCSC, Wharton Head and Neck Centre, Princess Margaret Hospital, 610 University Ave, Toronto, Ontario, Canada M5G 2M9; e- mail, ralph.gilbert@uhn.on.ca. Copyright © 2003 by the American Academy of Otolaryn- gology–Head and Neck Surgery Foundation, Inc. 0194-5998/2003/$30.00 + 0 doi:10.1016/S0194-5998(03)01393-7 547