title: Combined Anterolateral Thigh and Tensor Fasciae Latae Flaps: An Option for Reconstruction of Large Head and Neck Defects.
abstract: OBJECTIVE
  The advent of microvascular free tissue transfer has provided the reconstructive surgeon with an enormous array of treatment options for reconstruction of large head and neck defects. However, when indicated by defect size, the need for more than 1 flap not only increases surgical complexity but also patient morbidity. The combination of the anterolateral thigh (ALT) flap and the tensor fascia latae (TFL) flap can be used to reconstruct such complex head and neck defects, thereby minimizing any additional morbidity that would be imposed by an additional flap harvest site. The present study reports on the use of the combined ALT-TFL flap to reconstruct large and complex head and neck defects.
  
  
  METHODS
  A retrospective chart review was conducted of all microvascular head and neck reconstructions performed by the Maxillofacial Tumor and Reconstructive Surgery Service at the University of Miami/Jackson Health System (Miami, FL) from 2013 through 2016. Inclusion criteria for the study were head and neck defects at least 20 m × 10 cm and reconstruction with soft tissue flaps using perforating vasculature to the TFL and ALT vascular territories. Other study data included disease history, location of defect, flap size, recipient vessels, harvest time, ischemia time, surgical complications, and overall flap survival.
  
  
  RESULTS
  Seven patients met the inclusion criteria. Five patients were treated for the diagnosis of stage III osteoradionecrosis and 2 patients underwent reconstruction in conjunction with ablative surgery for head and neck carcinoma. All 7 patients underwent successful head and neck reconstructions using the ALT-TFL flap. There was no partial or total flap failure. One patient had a wound healing complication at the donor site that did not require surgical intervention.
  
  
  CONCLUSIONS
  Reconstruction of a large head and neck soft tissue defect with a combined ALT-TFL flap is a reliable method with minimal donor site morbidity and no major postoperative complications. This combined flap should be considered when the defect size extends beyond the bounds allowed by the ALT flap alone.
authors.affiliation: Assistant Professor of Surgery, University of Miami Miller School of Medicine, Miami, FL. Electronic address: r.tursun@med.miami.edu.
authors.forename: Ramzey
authors.initials: R
authors.lastname: Tursun
authors.affiliation: Head and Neck Tumor and Reconstructive Surgery Fellow, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Hisham
authors.initials: H
authors.lastname: Marwan
authors.affiliation: Assistant Program Director and Assistant Professor of Surgery, University of Miami Miller School of Medicine, Miami FL; Naval Medical Center Portsmouth, Portsmouth, VA; Uniformed Services University of Health Sciences, Bethesda, MD.
authors.forename: J Marshall
authors.initials: JM
authors.lastname: Green
authors.affiliation: Resident, Division of Oral and Maxillofacial Surgery, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Alotaibi
authors.affiliation: Head and Neck Tumor and Microvascular Reconstructive Surgery Fellow, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Andre
authors.initials: A
authors.lastname: LeDoux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018277:Carcinoma, Mucoepidermoid / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery; D063168:Mandibular Osteotomy; D008866:Microsurgery / Q000379:methods*; D055806:Microvessels / Q000601:surgery*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D010307:Parotid Neoplasms / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome