Song and colleagues were the first to describe the anterolateral thigh (ALT) flap in 1984. The ALT flap is widely used due to its many advantages: the possibility of working in two teams, long flap pedicle, adjustment of size and thickness, low morbidity of the donor site, etc. Also, the ALT flap allows taking different tissue components: skin, fascia and muscle in different combinations. The most common indications for using the flap are reconstruction of the head and neck, upper and lower limbs, abdominal wall, but the flap is also used for reconstruction of the breast, esophagus, perineum and penile reconstruction. The ALT flap is based on the perforators of the descending branch of the lateral circumflex femoral artery. Preoperatively, the approximate location of the perforator is marked using skin orientation points and Doppler probe. Perforators can be septocutaneous or myocutaneous, which is more often the case. If a myocutaneous perforator is present, intramuscular disection should be performed. In addition to the descending branch, the pedicle can be an oblique branch. The flap is usually incised subfascially. The most common complication at the donor site is paresthesia of the lateral part of the thigh. Other serious complications, such as compartment syndrome or muscle necrosis, are possible, but rare. The success rate of the flap is high. Donor site morbidity is minimal. In the majority of cases, muscle function is preserved, and aesthetic results are satisfactory.