Designing Perforator Flaps: Anterolateral Thigh Flaps

With the technological advances and increased understanding of perforator anatomy, microsurgery has evolved from the dawn of microsurgery to the era of personalized microsurgical reconstruction. After this paradigm shift, the goals of reconstruction transitioned from providing tissue coverage to restoring functional form. New types of flaps such as chimeric, thin, superthin, and perforator-based flaps were developed to further improve patient-centric reconstruction. Despite the versatility of these flaps, designing anterolateral thigh (ALT) flap in this configuration can be challenging due to variability in vascular anatomy and thickness of soft tissue, especially in Western countries. In this chapter, we will discuss tips and pearls of designing anterolateral thigh flap and the role of imaging in preoperative planning of the ALT flap.