Freestyle anterolateral thigh flap and perforator variations

Introduction: Anterolateral thigh (ALT) flap has become an increasingly popular reconstructive option, especially for head-and-neck and extremity defects. In addition to the many advantages of the ALT flap, there are also some disadvantages such as individual variations in the number and location of cutaneous perforators. Doppler ultrasonography (USG) is one of the most frequently used methods to overcome variations in perforator anatomy. However, the Doppler device may obtain false results so some clinics use the “freestyle” harvesting technique for ALT flap. The aim of the study is to examine experience with freestyle ALT flap harvesting and to evaluate the perforator variations. Materials and Methods: Between 2018 and 2021, 59 ALT flaps were harvested by the same microsurgical team for head-and-neck reconstructions. Of 59 patients, 23 were female and 36 were male. Cases were performed without using preoperative or peroperative imaging techniques. Results: In 2 (3%) of 59 patients, different septocutaneous flap options were used because suitable perforators could not be found in both thigh regions. For 57 ALT flaps, the rate of descending branch of lateral circumflex femoral artery (LCFA) perforators was 73%, transverse/ascending branch was 17%, aberrant perforators other than classical branches of LCFA was 7%, and the perforator from medial circumflex femoral artery was 1%. Partial necrosis due to perfusion problem was experienced in one flap and total necrosis was in two flaps. Conclusion: The advantages of the freestyle technique, such as allowing the evaluation of all perforators and designing flaps according to the appropriate perforator, provide great flexibility and convenience to the surgeon. With this, surgical problems caused by inaccurate results obtained by devices such as Doppler USG are excluded.