Surgical Technique for Anterolateral Thigh Flap Harvesting: A Questionnaire Study From 263 International Microsurgeons

The anterolateral thigh (ALT) flap is a very popular perforator flap, but variations in design and in harvest techniques result in a broad spectrum of approaches that considerably differ from literature descriptions. We therefore designed this study to assess the differences in surgical techniques and practice preferences toward this flap across world regions.The study was conducted via an online questionnaire covering demographic data, surgical techniques, and preferences in 21 questions. The participants were divided into six geographical regions that were compared. Two questions that are the subject of debate amongst microsurgeons (limitation of vasopressor use and anticoagulation before flap division) were further analyzed using a logistic regression to identify predicting variables.There were 263 respondents worldwide with notable differences in demographics, experience, level, and technique across different world regions. The main differences were noted in intraoperative evaluation of perforators, in the primary instrument for dissection, and in the use of loupe magnification. Microsurgeons in North America with limited experience were more likely to limit vasopressor use during flap harvest. There were also discrepancies regarding the use of systemic anticoagulation prior to flap division, but not of the same magnitude.This study is the first attempt to offer a clinical reference to apprehend differences in surgical preferences regarding ALT flap harvest techniques. Vasopressor use is notably limited by microsurgeons in North America, as well as by less experienced microsurgeons, despite available clinical evidence.