Background and objectives: The ALT has become one of the first choices for reconstruction in defects involving the oral cavity and oropharynx. Or aim is to review the indications for the ALT compared to other free flaps in maxillofacial reconstruction.

Material and methods: A retrospective analysis was performed of the patients reconstructed with ALT for oral cavity and oropharyngeal defects by our Department from 2007 to 2013. The indications, harvesting techniques, inset design and results are discussed.

Results: The ALT was harvested in 23 patients. These included 13 cases for soft tissue reconstruction, 4 for tongue, 3 for hard palate and 3 for composite defects. The majority were secondary to oncologic ablative surgery, and 3 were due to cocaine consumption. The use of a modified design of the ALT (“cathedral triptych”) for total lingual reconstruction is discussed. The results obtained were successful with a low donor site morbidity.

Conclusions: The ALT presents an emerging role in head and neck reconstruction due to its great versatility. Variable quantities of skin, fat, muscle and fascia can be harvested, making the reconstructive options with the ALT to be numerous.

Key words : reconstruction; anterolateral thigh; indications; design