Anteromedial thigh perforator free flap: Report of 41 consecutive flaps and donor-site morbidity evaluation

Background: The anterolateral thigh (ALT) flap is a workhorse flap in free tissue transfer but an alternative is needed in case of failure, no sizable perforators and for those cases where the ALT flap has already been used. The anteromedial thigh (AMT) flap provides a good amount of soft tissues, not increasing the number of donor sites. In this study, we reviewed a single-centre series of AMT flaps, evaluated the donor-site morbidity and discussed the indications for head and neck reconstruction. Methods: From 2006 to 2010, 41 consecutive AMT flaps in 39 patients were done. Donor-site morbidity was evaluated with subjective and functional assessment. At least 6 months after surgery, patients received a standard questionnaire and a bilateral kinetic test was performed to compare the AMT donor leg and the contralateral leg. Results: In every case, a sizable perforator was found and an AMT flap was harvested and re-vascularised. The average size of the flaps was 14.0 +/- 5.5 x 6.2 +/- 1.5 cm. The mean pedicle length was 8 cm (6-10 cm) and 30 of the perforators (73.2%) were true myocutaneous perforators. Two flaps were lost postoperatively and the assessed success rate was 95%. Donor-site morbidity evaluation showed very good subjective perception and good kinetic functional tests. No impairment in daily activity was found. Conclusion: The AMT flap is a very good and reliable option whenever the ALT flap is not available. It does not increase the number of donor sites, preserving a good lower-limb function. Levels of Evidence Therapeutic study: level III. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.