Vascular system anatomy of the anterolateral thigh flap
Aim: to analyze the anterolateral thigh flap use to eliminate oncological defects in the head and neck area with an emphasis on the flap raising characteristics. Patients and Methods: 146 patients aged 33 to 80 y.o. underwent the surgery in the period from 2011 to 2020. Single-stage reconstruction (143 surgeries) of the various parts of the upper aerodigestive tract (142 surgeries) was mainly performed. Most of the patients (130 cases) underwent the surgery at the first stage of antitumor treatment. In 13 cases, surgical treatment was performed concerning tumor recurrences; in 3 - delayed secondary reconstruction was performed. Flap raising was conducted according to the generally accepted method without the use of preoperative mapping of perforators. The surgery protocols and medical histories were analyzed for the patterns of vascular anatomy and the number and nature of flap-related complications. Results: typical vascular anatomy was noted in 115 cases (78.8%). When raising 31 flaps, anatomical deviations of the course and origin of cutaneous perforators were noted, which can be divided into 4 types: oblique branch anomaly (11 cases), upper type of anterolateral thigh flap (11), anteromedial thigh flap (6) and the rectus femoris muscle (3), while the latter type is rarely mentioned in the literature. The descending branch was the source of cutaneous perforator in 133 cases (91.1%). In 6 cases (3.9%), unfavourable vascular anatomy forced the use of a contralateral hip as a donor area. The reason for the failure in one of these cases was hypoplasia of the descending branch. The primary wound closure of the hip was performed in 143 patients (97.9%), even though the flap width exceeded 8 cm in 7 cases. Postoperative mortality was 1.4%. The main complications associated with the flap included: total flap loss (9 cases; 6.2%), partial necrosis (6; 4.1%) and donor wound complications (8; 5.5%). Conclusion: the anterolateral thigh flap is an excellent plastic material, however, it requires knowledge of the vascular anatomy characteristics of adjacent hip zones.