Utilization and Outcomes of Pedicled Anterolateral Thigh Flaps: A Systematic Scoping Review of the Literature

Background/Objectives: Pedicled anterolateral thigh (ALT) flaps have proven their versatility through various applications including in different tissue compositions in locoregional reconstructions. However, they are underutilized compared to their free counterparts. Our aim is to systematically review the studies published on the utilization of pedicled ALT flaps in various anatomical regions. Methods: A search was conducted using the PubMed and Embase databases including the terms: (“pedicled” OR “island”) AND (“ALT” OR “anterolateral thigh flap” OR “lateral circumflex femoral” OR “vastus lateralis” OR “rectus femoris”). Outcomes regarding etiology, location, number and composition of flaps, flap and defect size, tunnel of the pedicle, flap viability and complications were collected. Results: A total number of 133 studies met the inclusion criteria, of which the majority were case series. After excluding the case reports (n = 49), studies included in the review were grouped based on anatomical locations such as abdominal (n = 12), groin (n = 12), perineal–vaginal–vulvar (n = 11), penile (n = 15), trochanteric–ischial–sacrogluteal (n = 8) and multiple (n = 19). Among a total of 1227 flaps, there were 46 partial (3.7%) and 16 total losses (1.3%). Conclusions: The pedicled ALT flap has been gaining popularity in the past decade. The overall flap loss rate is relatively low. However, the level of therapeutic evidence of published studies is not high, and there is a large heterogeneity among methods. There is a need in the literature for comparative studies with larger cohorts. Further studies will help to establish guidelines and possible algorithms that could include pedicled ALT flaps as first-line management options in different anatomical locations.