Using the proximal perforator-based anterolateral thigh flap from the same donor site to salvage the reconstruction after failure of the distal perforator-based anterolateral thigh flap.
We presented a patient who experienced the anterolateral thigh (ALT) flap failure but the reconstruction was successfully salvaged by harvesting a second ALT flap from the same donor site 2 days after the first reconstruction. A 47-year-old man received cancer ablation for right mouth floor squamous cell carcinoma. The resultant defect was planned to be reconstructed with the ALT flap. During the flap dissection, we identified three proximal cutaneous perforators originating from the transverse branch of the lateral circumflex femoral artery (t-LCFA) and two distal cutaneous perforators originating from the descending branch (d-LCFA). We harvested a skin flap based on the distal two perforators and divided the d-LCFA just distal to the bifurcation of the d-LCFA and the t-LCFA. Unfortunately, the ALT flap showed venous congestion on postoperative day 2 and eventually failed. We harvested a second ALT flap from the same donor site based on the previously preserved perforators. The recovery course was smooth thereafter. We believe that the harvest of a second ALT flap from the same donor site may be an option, to avoid other donor site violation, in some patients who experienced the first flap loss. © 2014 Wiley Periodicals, Inc. Microsurgery 34:409-412, 2014.
Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Kun-Han
KH
Chen
Haw-Yen
HY
Chiu
Jing-Wei
JW
Lee
Shyh-Jou
SJ
Shieh
Yao-Chou
YC
Lee
D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D061525:Perforator Flap; D019651:Plastic Surgery Procedures / Q000379:methods; D016879:Salvage Therapy; D000077195:Squamous Cell Carcinoma of Head and Neck; D020858:Tissue and Organ Harvesting; D017211:Treatment Failure