Reverse Anterolateral Thigh Flap for Lower Extremity Reconstruction: A Scoping Review.

Background: There are several reconstructive methods in a plastic surgeon's toolbox for reconstruction of soft tissue deficits in the lower extremity. This study presents a comprehensive review of literature pertaining to reconstruction of the lower extremity with the reverse anterolateral thigh flap. Methods: A scoping review was conducted based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews methodology. A total of 4 databases were used for the literature search. Main outcomes measured included procedure performed, region of soft tissue deficit, complications, follow-up, and the need for reoperation. Results: A total of 985 studies were imported for screening, of which 6 studies were selected based on our inclusion and exclusion criteria. Sixty-nine patients were included, with the majority of defects involving the peripatellar region, followed by the proximal and middle third of the lower extremity, and the thigh. The aggregate complication rate was 21.7% with flap loss occurring in 3 (4.3%) patients. Nine (12.9%) patients required reoperation due to complete flap loss or delayed healing. Conclusions: The reverse anterolateral thigh flap is a versatile option for reconstruction of defects localized to the knee and the proximal and middle third of the lower extremity. Particularly, the flap should be considered in patients that are otherwise not candidates for typical forms of reconstruction with the gastrocnemius or soleus muscles or with a free flap.