The anterolateral thigh flap in head and neck reconstruction: "pearls and pitfalls".

The anterolateral thigh (ALT) flap has found a permanent and highly valued place in head and neck reconstruction because of its versatility, two-team method of operating, and favourable donor site. The principal disadvantages are related to unpredictable vascular anatomy and the need to meticulously dissect the perforator. With these issues in mind we present a series of practical "pearls and pitfalls". Our experience has not only given us more confidence to use this flap in an increasing variety of defects, but also given us a new perspective on the applicability of chimeric flaps and perforator techniques in a wide range of donor sites.