J Reconstr Microsurg 2010; 26(1): 067-072
DOI: 10.1055/s-0029-1234023
© Thieme Medical Publishers

Designing the Anterolateral Thigh Flap without Preoperative Doppler or Imaging

Samuel J. Lin1 , Amr Rabie1 , Peirong Yu2
  • 1Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  • 2Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Further Information

Publication History

Publication Date:
11 August 2009 (online)


The anterolateral thigh (ALT) flap is now considered a workhorse for head and neck reconstruction in many centers. However, designing and raising the ALT flap has been traditionally recognized as being difficult, tedious, and technically demanding due to its variation in perforator anatomy. Designing the ALT flap on data gained solely using the handheld Doppler can be misleading, as its specificity and sensitivity varies greatly depending on amount of subcutaneous fat and the Doppler itself. Authors have investigated multiple imaging modalities in the search of the best way to predict and map the site and size of perforators before dissecting a flap. In this article, we describe a simplified technique for the ALT flap design and dissection without the use of preoperative imaging or vascular studies. Utilizing anatomic landmarks, the location of the three perforators (A, B, and C) can be anticipated and safely dissected. We conclude that accurate use of the ABC system is one approach in consistently dissecting the ALT flap.


Peirong YuM.D. 

Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center

1515 Holcombe Blvd, #443, Houston, TX 77030

Email: peirongyu@mdanderson.org