Anterolateral thigh flap: systematic literature review of specific donor-site complications and their management

Background: The anterolateral thigh flap (ALT) is one of the most common flaps used in reconstructive microsurgery, due to its demonstrated lower donor-site morbidity when compared to other sites. Despite this, there are case reports of specific donor-site complications following the raising of an ALT flap. To date, there has been no systematic review of ALT-flap-related complications and overall ALT donor-site morbidity.

Methods: A systematic review of the English-language literature was performed to identify specific donor-site complications following ALT-flap creation.

Results: Fifteen articles met the study criteria and were included for analysis. ALT-flap donor-site complications were classified according to the tissue component involved (vessels/nerves, deep fascia, muscles).

Conclusions: Donor-site morbidity following raising of an ALT flap is minimal. ALT-flap versatility fulfils all of the needs of reconstruction, however we identified less common, but straightforward, complications that occurred when elevating overly large skin paddles (with widths measuring more than 10-12 cm), when sacrificing a main motor branch, when developing the pedicle too far proximally, when including too much fascia and when neglecting proper haemostasis. We suggest a basic algorithm for minimising donor-site morbidity and controlling complications, thereby reducing overall patient morbidity, shortening hospital stays and reducing costs.