Application of the ALT suprafascial flaps in head and neck cancer reconstruction

초록

Head and neck(H/N) reconstructions require great attention to detail, and there is no room for error. A tiny mistake can lead to a series of problems and failure of reconstruction. Ideal reconstruction of the H/N is restoring of the functional recovery of the laryngopharynx, well tubed conduit for the passage food, facial covering cosmetically accepted with reliable flap having appropriate thickness. The anterolateral thigh (ALT) flap is known as a versatile flap and gaining widespread popularity as a workhorse in reconstructive surgery because of its long vascular pedicle, pliable skin paddle and minimal donor site morbidity. But, The ALT flap in most patients is thicker than desired. The flap can be thinned by direct excision of subcutaneous fat at the periphery of the flap. In most cases, this is all that is needed for thinning. The suprafascial ALT elevation permits the harvest of a thin flap with less donor-site morbidity by preserving the fascia. This flap can make well tubed neo-esophagus with wide lumen, and be trimmed to the subdermal fat level for use as an ultra thin flap, which is appropriate for reconstruction of head and neck defects. Suprafascial dissection techniques help to mitigate some of the thickness issues without compromising vascular supply, and become more pliable and stretchable with or without ongoing defatting of the superficial fat layer. This flap tissue could be draped favorably in the oropharynx, esophagus, and facial covering with thin thickness flap. The aim of this presentation is to describe the suprafsacial ALT elevation methods for making thin flap and to discuss their advantages and drawbacks.