Abstract
We report a 74-year-old man with malignant tumor of the chest wall. He underwent wide local excision and reconstruction with combined free anterolateral thigh (ALT) and tensor fascia latae (TFL) flap using intraflap flow-through anastomoses. The designed flap was 20 × 11 cm in size; however, the flap pedicles of the ALT perforators were smaller than expected. Considering that the ALT perforators would not have yielded a sufficient perforasome, we included TFL perforator in the flap. Intraflap anastomosis of the artery and vein of the TFL perforator was performed with the distal end of the descending branches of the lateral circumflex artery and vein. This combined flap was transplanted to cover the chest wall defect. The flap healed without postoperative complications. This report shows that intraflap anastomoses for two different pedicles can be useful for no more than one artery and vein at the recipient site and also allows for preservation of the other lateral circumflex branches.
Level of evidence: Level V, therapeutic study.
Similar content being viewed by others
References
Tukiainen E (2013) Chest wall reconstruction after oncological resections. Scand J Surg 102(1):9–13
Cordeiro PG, Santamaria E, Hidalgo D (2001) The role of microsurgery in reconstruction of oncologic chest wall defects. Plast Reconstr Surg 108(7):1924–1930
Di Candia M, Wells FC, Malata CM (2010) Anterolateral thigh free flap for complex composite central chest wall defect reconstruction with extrathoracic microvascular anastomoses. Plast Reconstr Surg 126(5):1581–1588
Lu JC, Zelken J, Hsu CC, Chang NJ, Lin CH, Wei FC, Lin CH (2015) Algorithmic approach to anterolateral thigh flaps lacking suitable perforators in lower extremity reconstruction. Plast Reconstr Surg 135(5):1476–1485
Namgoong S, Yoon YD, Yoo KH, Han SK, Kim WK, Dhong ES (2018) Alternative choices for anterolateral thigh flaps lacking suitable perforators: a systematic review. J Reconstr Microsurg 34(7):465–471
Sasaki K, Nozaki M, Nakazawa H, Kikuchi Y, Huang T (1998) Reconstruction of a large abdominal wall defect using combined free tensor fasciae latae musculocutaneous flap and anterolateral thigh flap. Plast Reconstr Surg 102(6):2244–2252
Dillon AB, Sinno S, Blechman K, Berman R, Saadeh P (2015) Functional reconstruction of a large anterior thigh defect using contralateral anterolateral thigh flap with tensor fasciae latae and motorized vastus lateralis. J Reconstr Microsurg 31(1):79–82
Kimura N, Saito M, Itoh Y, Sumiya N (2006) Giant combined microdissected thin thigh perforator flap. J Plast Reconstr Aesthet Surg 59(12):1325–1329
Huang WC, Chen HC, Jain V, Kilda M, Lin YD, Cheng MH, Lin SH, Chen YC, Tsai FC, Wei FC (2002) Reconstruction of through-and-through cheek defects involving the oral commissure, using chimeric flaps from the thigh lateral femoral circumflex system. Plast Reconstr Surg 109(2):433–441 discussion 442-433
Deleyiannis FW, Badeau AM, Leem TH, Song JI (2014) Supercharging and augmenting venous drainage of an anterolateral thigh free flap: options and indications. Plast Reconstr Surg Glob Open 2(4):e135
Tursun R, Marwan H, Green JM 3rd, Alotaibi F, LeDoux A (2017) Combined anterolateral thigh and tensor fasciae latae flaps: an option for reconstruction of large head and neck defects. J Oral Maxillofac Surg 75(8):1743–1751
Brunetti B, Morelli Coppola M, Tenna S, Persichetti P (2019) The lateral thigh perforator propeller flap: a reliable backup plan for locoregional reconstruction in case of missing or unreliable anterolateral thigh perforators. Plast Reconstr Surg 143(1):248e–249e
Koshima I (2000) Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 105(7):2358–2360
Maruccia M, Di Taranto G, Nicoli F, Ciudad P, Giudice G, Chen HC (2017) Rectus femoris muscle necrosis: an underrated donor-site complication of free anterolateral thigh flap. J Plast Reconstr Aesthet Surg 70(7):972–974
Hallock GG (2011) The complete nomenclature for combined perforator flaps. Plast Reconstr Surg 127(4):1720–1729
Koshima I, Fujitsu M, Ushio S, Sugiyama N, Yamashita S (2005) Flow-through anterior thigh flaps with a short pedicle for reconstruction of lower leg and foot defects. Plast Reconstr Surg 115(1):155–162
Yokota K, Sunagawa T, Suzuki O, Nakanishi M, Ochi M (2011) Short interposed pedicle of flow-through anterolateral thigh flap for reliable reconstruction of damaged upper extremity. J Reconstr Microsurg 27(2):109–114
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Patient consent
The patient discussed in this case report provided consent for photographs and discussion in accordance with institutional policies.
Funding information
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Conflict of interest
Keisuke Shimbo and Kazunori Yokota declare that they have no conflict of interest.
Ethical approval
Not applicable.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Shimbo, K., Yokota, K. Combined anterolateral thigh and tensor fasciae latae flap using intraflap flow-through anastomoses in a case of chest wall reconstruction. Eur J Plast Surg 43, 335–338 (2020). https://doi.org/10.1007/s00238-019-01567-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-019-01567-1