A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients

Background: The anterolateral thigh free flap may be harvested as a fasciocutaneous perforator flap or as a myocutaneous flap by including variable amounts of the vastus lateralis muscle. The authors sought to determine the donor-site morbidity associated with both types of flap dissection. Methods: Between 2005 and 2008, the authors performed 220 reconstructive operations using the anterolateral thigh free flap. Complications and donor-site function were evaluated prospectively. Results: Variable amounts of vastus lateralis muscle were harvested with the flap in this series: 25 percent included no muscle, 38 percent included minimal muscle, 33 percent included the superficial half of the muscle, and 4 percent included the entire muscle. The motor nerve to the vastus lateralis muscle was spared during dissection of the flap pedicle in 78 percent but required division in 22 percent. Complications included seroma (5 percent), wound dehiscence (2 percent), hematoma (1 percent), infection (1 percent), neuroma (1 percent), and partial skin graft loss (1 percent). Eighty-four percent of patients reported a sensory loss in the distribution of the lateral femoral cutaneous nerve. Weakness or instability was reported by 8 percent of patients at their initial postoperative visit but resolved in all patients within 6 months. All patients regained their postoperative level of activity. Conclusions: The anterolateral thigh free flap is associated with a low rate of complications and functional morbidity. Even when the motor nerve to the vastus lateralis is divided, or substantial amounts of thigh fascia or vastus lateralis muscle are included in the flap design, all patients return to their preoperative level of function.