Abstract: Objectives   To investigate the clinical efficacy of individualized precision design using anterolateral thigh perforator flaps for reconstructing various complex tissue defects.    Methods   A retrospective analysis was conducted on 1079 patients who underwent reconstruction using individualized precision-designed anterolateral thigh perforator flaps at our department from January 2013 to January 2023. The descending branches of the lateral circumflex femoral artery were utilized as the vascular pedicle (including 65 pediatric cases) in 1013 cases, transverse branches in 40 cases, oblique branches (including 1 pediatric case) in 26 cases, and descending branch of the medial circumflex femoral artery or femoral artery perforators as the pedicle in 9 cases. Procedures included 441 cases of free flap transplantation, 27 cases of pedicle transfer, 511 cases of basic types of special form perforator flaps, and 100 cases of derivatives. Defects repaired included 787 cases in the lower limbs, 264 cases in upper limbs, 17 cases in trunk, 4 cases in head-neck region and 7 cases in multiple sites. Postoperative clinical outcomes and complication rates of various individualized precision designs of anterolateral thigh perforator flaps were statistically analyzed and compared.   Results   Among the 1079 cases of anterolateral thigh perforator flaps, 1063 cases survived postoperatively, with 14 cases undergoing vascular exploration due to vascular crisis, yielding an overall success rate of 98.52%. Comparison of success rates among free anterolateral thigh perforator flaps, pedicled flaps, basic types and derivatives of special form perforator flaps revealed no significant differences in success rates (P>0.05). Complications included venous crisis in 35 cases (3.24%), arterial crisis in 22 cases (2.04%), infection in 19 cases (1.76%), delayed wound healing in 6 cases (0.56%), complete necrosis in 16 cases (1.48%), and partial necrosis in 35 cases (3.24%). In terms of venous crisis, the incidence rate of perforator flaps in basic types group was lower than that in derivatives group (P<0.001). Regarding wound infection, the incidence rate in pedicled flap group was higher than that of basic types group (P = 0.007). For delayed wound healing, the incidence rate of perforator flaps in traditional free flaps group was higher than that in basic types group (P = 0.04). In terms of partial flap necrosis, the incidence rate in pedicled flap group was higher than that of basic types group (P=0.008).    Conclusions   Individualized precision design of anterolateral thigh perforator flaps could achieve favorable clinical outcomes and merit further clinical application and promotion.

Key words: Anterolateral thigh,  ,  , Perforator flaps,  ,  , Individualized,  ,  , Precision reconstruction,  ,  , Skin and soft tissue defects