Anterolateral thigh harvesting for head and neck reconstruction without Doppler: Risky or not?

Abstract

Background: Anterolateral thigh flap (ALT) is used as a workhorse flap for head and neck reconstruction. The most used method to map the perforators nowadays is hand-held Doppler although several more sophisticated techniques have been described. This paper is to investigate whether harvesting the ALT flap without preoperative mapping is safe. Materials and methods: Twenty consecutive patients were randomly assigned to one of two groups: A or B. Patients of A group (n = 10) were marked before the operation with the use of a Doppler probe whilst patients of group B (n = 10) were not marked preoperatively using Doppler to detect the perforators. Complications and time of ALT dissection were documented. Results: There was no statistical difference of complications between the two groups. Mean time of flap harvesting (skin incision up to main pedicle) was approximately 140 min in group A and 165 min in group B (statistically significantly less in group A p = 0.008). Conclusions: This paper is an indication that harvesting the ALT flap without preoperative mapping, even with hand-held Doppler, does not compromise safety of the procedure although operative time is prolonged.

Keywords

• Anterolateral thigh flap
• Perforators mapping
• Head and neck reconstruction
• Computed tomography angiography
• Magnetic resonance angiography
• Thermal imaging