Abstract: Objective    To explore the clinical applications of the anterolateral thigh (ALT) perforator propeller flap and its alternatives in repairing different regions.   Methods   Between November 2009 and December 2023, a total of 45 patients were prepared for the harvest of the ALT propeller flap and reviewed. The clinical application and alternatives of the ALT perforator propeller flap were summarized.   Results    Of the 45 patients, 39 cases of (86.7%) ALT perforator propeller flap were harvested as planned; six (13.3%) were converted to other perforator propeller flap due to lack of suitable perforators in the ALT region. Among them, the source blood vessels of other perforating branch of propeller flap included femoral rectus branch in 2 cases.  one case from the transverse branch of the lateral circumflex femoral artery, one case of the femoral artery, one case of the profunda femoris artery, and one case of the superior lateral genicular artery, respectively. Two flaps developed obstruction of venous congestion, one survived after conservative treatment, and one had distal flap necrosis, which was salvaged with a peroneal artery perforator propeller flap. Conclusions    The ALT perforator propeller flap can be used to reconstruct defects located from the groin to the knee. When the perforators in the ALT region are not available, perforators from the rectus femoris branch, femoral artery, superior lateral genicular artery, or profunda femoris artery can be used as the pedicle for harvesting a perforator propeller flap which can be used for defect reconstruction.

Key words: Anterolateral thigh flap,  ,  , Perforator vessel,  ,  , Propeller flap,  ,  , Soft-tissue reconstruction, Alternative solution