title: Treatment of a mastoid defect by free anterolateral thigh flap.
abstract: BACKGROUND
  Free anterolateral thigh (ALT) flap constitutes an alternative to latissimus dorsi and radial forearm flaps for head and neck reconstruction. The authors report a case of mastoid reconstruction in a patient with multi-operated cholesteatoma associated with tubal dysfunction.
  
  
  METHODS
  This patient presented a fistula of the lateral semicircular canal and invagination of retroauricular soft tissues responsible for non-compensated almost complete areflexia with anacusis. She did not present any signs of cholesteatoma recurrence, but chronic inflammation of the mastoidectomy cavity. The head and neck procedure consisted of translabyrinthine labyrinthectomy: resection of the atrophic retroauricular skin, resection of the vestibular neurosensory tissue and obliteration of the mastoidectomy cavity. An ALT flap measuring 5×5 cm, anastomosed to the superior thyroid artery and facial vein, was used to cover the defect. Careful defatting of the flap allowed filling of the defect, while providing a sufficient quantity of appropriate tissue. The postoperative course was uneventful and the patient was considerably improved. The only donor site sequelae consisted of a thin linear scar.
  
  
  CONCLUSIONS
  The free anterolateral thigh flap, a reliable, polyvalent flap that can be shaped as needed and which is associated with minimal donor site morbidity, constitutes a good alternative for head and neck reconstruction.
authors.affiliation: Service de chirurgie plastique, reconstructrice et esthétique, hôpital de la Conception, CHU, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France. Electronic address: pascalsebastien@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Pascal
authors.affiliation: Service ORL et chirurgie cervico-faciale, laboratoire de biomécanique appliquée, UMR T24, IFSTTAR, Aix-Marseille université, CHU Hôpital-Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Deveze
authors.affiliation: Service de chirurgie plastique, reconstructrice et esthétique, CHU Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France.
authors.forename: D
authors.initials: D
authors.lastname: Casanova
authors.affiliation: Service de chirurgie plastique, reconstructrice et esthétique, CHU Hôpital-Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Philandrianos
mesh_terms: D018424:Cholesteatoma, Middle Ear / Q000150:complications / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D006801:Humans; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012665:Semicircular Canals / Q000601:surgery; D013524:Surgical Flaps
keywords: Anterolateral; Defect; Flap; Free; Head and neck; Labyrinth; Mastoid