Combined anterolateral thigh and tensor fasciae latae flap using intraflap flow-through anastomoses in a case of chest wall reconstruction

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.