A novel combination flap of anterolateral thigh flap (ALT) and rectus femoris flap for perineal defects

Abstract

The pedicled anterolateral thigh flap (ALT) has gained importance in perineal reconstruction. Especially, the combination with muscle tissue, in the form of a chimeric flap, has clearly increased its versatility and range of application. Thus, both the skin paddle and the muscle seal, filling the dead space within the small pelvis, can be used to exactly reconstruct the defect. Nevertheless, the lateral circumflex femoral artery system is known for its vascular variability. We report a case, where we planned to close a perineal defect with a combination flap of vastus lateralis muscle and ALT flap. However, the ALT was found perfused by vessels perforating the rectus femoris muscle instead of the vastus lateralis, which gained its main perfusion by the transverse branch of the lateral circumflex femoral artery. Thus, the defect was successfully reconstructed with a combination flap of ALT and rectus femoris muscle tissue. The variable anatomy of the lateral circumflex femoral artery system is one of the main challenges of the ALT flap, frequently demanding creativity and the usage of freestyle flap design. Therefore, it is possible to make a virtue out of necessity.