Maximizing the Utility of the Pedicled Anterolateral Thigh Flap for Locoregional Reconstruction

The pedicled anterolateral thigh (PALT) flap is an underutilized flap for locoregional reconstruction largely because methods to maximize its reach are neither universally implemented nor fully understood. In addition, most of the available literature has focused on the utility of the free anterolateral thigh flap with less emphasis on the PALT flap. Moreover, flap design concepts to maximize its utility and reach and optimize outcomes have not been comprehensively described. In an effort to address this knowledge gap, the authors sought to review their institution’s experience with the PALT flap for locoregional reconstruction.

Key points

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The pedicled anterolateral thigh flap (PALT) is reliable, has a good arc of rotation, and can be harvested as a fasciocutaneous flap with or without muscle depending on local anatomy and reconstructive needs. All these features make the flap a versatile option for locoregional reconstruction.
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Understanding the anterolateral thigh (ALT) flap vascular anatomy and its variations helps in flap design and reach.
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When ligating the arterial branch to the rectus femoris muscle, the secondary blood supply to the muscle must be assessed before ligation to avoid muscle necrosis. Also, during ALT flap harvest, care should be taken to preserve the minor pedicles to the rectus femoris muscle and ensure muscle viability.
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Tunneling the flap deep to the rectus femoris and sartorius muscles, ligating the arterial branch to the rectus femoris when deemed necessary and safe, and including the largest distal skin paddle perforator are all key factors in maximizing the reach of the PALT flap for locoregional reconstruction.