Objective: To explore the value of different designed anterolateral thigh flaps(ALT) in the reconstruction of buccal defect after radical resection of buccal cancer. Methods: From March 2009 to May 2016, 142 cases were diagnosed as buccal cancer in the Department of Oral and Maxillofacial Surgery of Nanjing University. All patient underwent radical resection, followed by reconstruction with different anterolateral thigh flaps. The clinical date were retrospectively analyzed. Results: Among 142 cases, the muscuiocutaneous ALT flaps were used in 60 cases, the fasciocutaneous ALT flaps in 60, and the thin ALT flaps in 22. The size of the flaps ranged from 4 cm×5 cm to 14 cm×10 cm. Operative exploration during the perioperative period were performed in 4 patients, including 2 flaps with thrombotic events and 2 flaps with venous thrombosis. Among them, 2 flaps survived completely and 2 flaps were failure. The mean follow-up period was 37 months(range: 3 to 85 months). Conclusions The different designed anterolateral thigh flap for the buccal defects resulting from tumour excision is an ideal choice for reconstruction of buccal defects.