الفهرس 
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Abstract
Reconstruction of the head and neck continues to pose a formidable
challenge for maxillofacial and plastic surgeons. Cancer, trauma, and congenital
anomalies are the primary reasons for patients to seek repair. The simple fact that
this anatomical region lies in such an obvious location makes cosmetic camouflage
difficult. Defects of any size can have a dramatic effect on cosmesis, speech,
respiration, and alimentation, which may significantly impact a patient’s quality of
life, the role of the reconstructive surgeon is to have a diverse armamentarium of
reconstructive options to enable an aesthetic and functional reconstruction while
minimizing the morbidity to the patient.
The anterolateral thigh free flap (ALT) has emerged as a popular option for
reconstruction of head and neck defects. It has the attributes of a “workhouse” flap
which include absence of patient repositioning, remote location from the potential
defect, and a long pedicle.
The ALT was first described by Song in 1984. It should be emphasized that
the skin associated with this flap is anterolateral thigh skin and that the pedicle is
almost the descending branch of the lateral circumflex femoral artery.
The unique anatomy of the thigh permits several methods of
harvesting the ALT flap. The type of tissues to be included in the flap can be
selected according to the defect to be reconstructed. The ALT flap can be
harvested at the suprafascial level to include just skin and subcutaneous fat, which
is useful when a thin flap is desired. When harvested at the subfascial level, the
flap can bring additional tissue bulk including the fascia lata on the deep surface.
A musculocutaneous flap can be harvested by including part of the vastus lateralis
muscle.
In this thesis, a study was made to evaluate indications,
advantages, disadvantages and complications of usage of anterolateral thigh flap as
a free flap in head & neck reconstruction.
The study include 3 patients ( all are females ) ranged in age from 41 to 55y
who had extensive soft tissue defect in head & neck after malignant tumor excision
and have been reconstructed by free ALT flap.
The flap perforator was a musclocutaneous perforator and originated form the
descending branch of lateral circumflex femoral in all cases. The length of the
pedicle ranged from 10 to 15 cm. In all the cases the pedicle was composed of one
artery and two veins. The flaps ranged in size from 10 to 16 cm in length and 7 to
15 cm in width. The donor site was closed primarily in the 3 cases. Two flaps
survived completely and one suffered from complete necrosis due to failure of
microvascular anastomosis and was managed by replacement of the flap by
pedicled pectorals major flap.
The duration of post-operative hospital stay ranged from 12- 14 day. There was
no post-operative wound infection or dog ear formation in the donor site.
According to recipient site, the flap was bulky in one case and no post-operative
hemorrhage or local abscess was recorded.