Abstract
We describe five technical notes to facilitate rapid elevation of the anterolateral thigh flap for extremity reconstruction. We highlight the advantages of (1) a lateral approach; (2) identification of the perforator with the shortest intramuscular distance; (3) deroofing technique with cutting monopolar for pedicle dissection; (4) taking a cuff of vastus lateralis in some cases to avoid unnecessary long perforator dissection; and (5) closure of large donor sites with a modified keystone flap. Using the sequence reduces flap-raising times to 60 to 90 minutes and improves theater usage while achieving excellent outcomes.