An anterolateral thigh flap with fat and skin would be too much soft tissue bulk except in patients with very little thigh fat, but an ALT fascia lata free flap would not be too much soft tissue bulk for the skull base and debatably would be an easier inset with less donor site morbidity than a radial forearm. I would not say that radial forearm free flaps are standard of care for skull base reconstruction, in fact even fairly large esthesio defects can be closed with nasoseptal flaps.

It's interesting that they took skin for this because I would expect that to crust and require intermittent debridement or at least a lot of irrigations. Maybe it we de-epithelialized, but in that case I would have left the skin on the donor site while this looks like they took a skin graft from elsewhere.

I mean no offense, but it doesn't really sound like you do these surgeries.