Assessing donor site morbidity of the anterolateral thigh flap after extremity reconstruction

The anterolateral thigh (ALT) flap has become a workhorse flap for plastic surgeons due to its versatility. These flaps comprise a significant amount of skin and soft tissue and feature a reliable vascular pedicle with a wide diameter, allowing for their use either freely or as a vascular pedicle. However, complications at the donor site can vary widely, affecting both the aesthetic appearance and functionality of the thigh, ranging from minor to more complex issues. This study evaluates the aesthetic and functional outcomes at donor sites for patients who underwent free ALT flap surgery to reconstruct limb soft tissue defects. A total of 97 ALT flaps were performed on 97 patients. The research examines various factors, including flap size, composition, and donor site closure techniques, to determine their impact on the aesthetics and functionality of the donor area. Early complications occurred in 11.3 % of the patients, including problems such as wound infections, wound margin necrosis, partial skin graft necrosis, and compartment syndrome. At a minimum 2-year follow-up, nearly all patients reported some degree of sensory reduction; however, none experienced local pain or significant sensory disturbances. Statistically significant differences were noted in thigh circumference and muscle strength between the donor and the contralateral thighs. Most patients reported satisfaction with their aesthetic results, though some, especially women, expressed dissatisfaction due to scarring. While early complications were generally mild and manageable, cosmetic outcomes could be negatively impacted by issues such as keloid scars and hypertrophy at the donor site, ultimately affecting patient satisfaction.