{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T11:23:44Z","timestamp":1764761024450,"version":"3.46.0"},"reference-count":22,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Free tissue transfer for coverage of large defects is a common technique in plastic surgery. The kind of free tissue transfer depends on various factors such as the size of the defect, type and content of missing tissue, the location, and the weight-bearing demands of the area. Instead of performing bulky muscle free flaps, another alternative has bas been considered. Materials and Methods: This is a technical experience report for ALTP Flap Surgery conducted from 2013 to 2017 which included 15 surgery reviews out of 50 based on the inclusion criteria to identify the result of aesthetical reconstruction and to include such results with the current literature. In addition to that, a narrative review of the literature has been performed using PubMed and Google Scholar by using the ALT or ALTP Flap terms to determine the current practice and to compare with our results. Results: Single-stage debridement of all defects was followed by reconstruction in all surgeries. A total of 14 Flaps succeeded (93.3%) without any complications and only one of the flaps was complicated (6.7%) with vein thrombosis which resulted in the loss of that flap, leading to another revision being performed for that particular patient. No hematoma or infection has been noted. Conclusions: Using an extended-size ALTP flap can be a reliable option for the reconstruction of the weight-bearing area of the foot and offers a good postoperative function and esthetic result without the need of further subsequent debulking procedures.<\/jats:p>","DOI":"10.3390\/medicina61122154","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T10:34:01Z","timestamp":1764758041000},"page":"2154","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anterior Lateral Thigh Perforator (ALTP) Flaps: Literature Review and Technical Experience to Pushing the Limits Toward Aesthetical Reconstruction"],"prefix":"10.3390","volume":"61","author":[{"given":"Ziyad","family":"Alharbi","sequence":"first","affiliation":[{"name":"Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah 23323, Saudi Arabia"},{"name":"Clinical Sciences Department, Fakeeh College for Medical Sciences, Jeddah 23323, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7538-4780","authenticated-orcid":false,"given":"Sarah","family":"Qari","sequence":"additional","affiliation":[{"name":"Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah 23323, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tala","family":"Zafar","sequence":"additional","affiliation":[{"name":"College of Medicine, King Abdulaziz University (KAU), Jeddah 21589, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faris","family":"Almarzouqi","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Dr. Sulaiman Al-Habib Hospital, Jeddah 22245, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4251-4128","authenticated-orcid":false,"given":"Benedikt","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery and Burn Unit, RWTH Aachen University, 52062 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Hertelendy","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Kaiserswerther Diakonie Florence-Nightingale-Krankenhaus, 40489 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3016-1580","authenticated-orcid":false,"given":"Savas","family":"Tsolakidis","sequence":"additional","affiliation":[{"name":"Austrian Cluster of Tissue Regeneration and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Research Centre for Traumatology of the Austrian Workers\u2019 Compensation Board (AUVA), Donaueschingenstra\u00dfe 13, 1200 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anas","family":"Fathuldeen","sequence":"additional","affiliation":[{"name":"College of Medicine, Hail University, Hail 55476, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Oliver","family":"Rennekampff","sequence":"additional","affiliation":[{"name":"Department of Plastic and Aesthetic Surgery, Burn Surgery, Rhein-Maas Klinikum, 52146 W\u00fcrselen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.bjps.2007.03.008","article-title":"Rational flap selection and timing for coverage of complex upper extremity trauma","volume":"60","author":"Herter","year":"2007","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/PRS.0b013e318254b128","article-title":"Supermicrosurgical reconstruction of large defects on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps","volume":"130","author":"Kim","year":"2012","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.bjps.2005.07.015","article-title":"More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap","volume":"59","author":"Lin","year":"2006","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.bjps.2011.08.043","article-title":"The anterolateral thigh\u2013vastus lateralis conjoint flap for complex defects of the lower limb","volume":"65","author":"Wong","year":"2012","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1055\/s-0043-1770956","article-title":"Reconstruction of Upper and Lower Limb Defects with Medial Sural Artery Perforator Flaps: Is Aesthetics Worth the Effort? A Retrospective Analysis","volume":"9","author":"Alharbi","year":"2023","journal-title":"Surg. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/01.prs.0000436845.92623.9a","article-title":"Muscle-sparing TRAM flap does not protect breast reconstruction from postmastectomy radiation damage compared with the DIEP flap","volume":"133","author":"Garvey","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1097\/01.PRS.0000076221.25738.66","article-title":"Free anterolateral thigh adipofascial perforator flap","volume":"112","author":"Hsieh","year":"2003","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S0007-1226(97)91363-1","article-title":"Forearm free skin flap transplantation: A report of 56 cases. 1981","volume":"50","author":"Yang","year":"1997","journal-title":"Br. J. Plast. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1002\/micr.30248","article-title":"Suprafascial versus traditional harvesting technique for free antero lateral thigh flap: A case-control study to assess the best functional and aesthetic result in extremity reconstruction","volume":"37","author":"Maruccia","year":"2017","journal-title":"Microsurgery"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1097\/PRS.0000000000002496","article-title":"Suprafascial Anterolateral Thigh Flap Harvest: A Better Way to Minimize Donor-Site Morbidity in Head and Neck Reconstruction","volume":"138","author":"Chen","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1097\/00006534-199609000-00015","article-title":"Choice of flap and incidence of free flap success","volume":"98","author":"Kroll","year":"1996","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1055\/s-0036-1584204","article-title":"Versatility of the free anterolateral thigh flap in the reconstruction of large defects of the weight-bearing foot: A single-center experience with 20 consecutive cases","volume":"32","author":"Pappalardo","year":"2016","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/PRS.0b013e3182729e3c","article-title":"Reconstruction of distal limb defects with the free medial sural artery perforator flap","volume":"131","author":"Wang","year":"2013","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1097\/00006534-200111000-00027","article-title":"The medial sural artery perforator free flap","volume":"108","author":"Cavadas","year":"2001","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1002\/micr.30100","article-title":"The free medial sural artery perforator flap: Versatile option for soft tissue reconstruction in small-to-moderate size defects of the foot and ankle","volume":"38","author":"Jandali","year":"2018","journal-title":"Microsurgery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1097\/PRS.0b013e3181b457cf","article-title":"Comparison of the medial sural artery perforator flap with the radial forearm flap for head and neck reconstructions","volume":"124","author":"Kao","year":"2009","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1097\/PRS.0b013e3181d180ac","article-title":"Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction","volume":"125","author":"Kao","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/00005373-200502000-00016","article-title":"Free medial sural artery perforator flap for resurfacing distal limb defects","volume":"58","author":"Chen","year":"2005","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1097\/SAP.0b013e3181835abf","article-title":"Plantar reconstruction using the medial sural artery perforator free flap","volume":"62","author":"Kim","year":"2009","journal-title":"Ann. Plast. Surg."},{"key":"ref_20","first-page":"187","article-title":"Medial sural artery perforator free flap: Legitimate use as a solution for the ipsilateral distal lower extremity defect","volume":"30","author":"Hallock","year":"2014","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1016\/j.joms.2014.05.019","article-title":"A prospective study of medial sural artery perforator flap with computed tomographic angiography-aided design in tongue reconstruction","volume":"72","author":"He","year":"2014","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1097\/TA.0b013e318203179e","article-title":"The medial sural artery perforator flap: A versatile donor site for hand reconstruction","volume":"70","author":"Lin","year":"2011","journal-title":"J. Trauma Acute Care Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2154\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T11:15:39Z","timestamp":1764760539000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":22,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["medicina61122154"],"URL":"https:\/\/doi.org\/10.3390\/medicina61122154","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,3]]}}}