Conjoint Anterolateral Thigh Fasciocutaneous and Vastus Lateralis Muscle Free Flaps for Reconstruction of Head and Neck Defects: A More Reliable and Versatile Alternative

Abstract

The anterolateral thigh (ALT) free flap is one of the most preferred options for soft-tissue reconstruction. Combined with the vastus lateralis (VL) muscle, either musculocutaneous flap or conjoint flap can be used. However, these are two distinct entities that need to be further elucidated. Between July and August of 2004, 8 patients underwent reconstruction using the conjoint ALT fasciocutaneous and VL muscle free flaps for head and neck defects. These procedures were indicated in 7 patients for immediate reconstruction following cancer ablation and in 1 patient for simultaneous reconstruction of scalp and dural defect resulted from post-traumatic infection. The ALT fasciocutaneous flaps were used to resurface the defects of oral lining, external cheek or scalp and dura. The VL muscle components were used for cheek augmentation, obliteration of the maxillary antrum, or improvement of local vascularity. For each flap, the skin and muscle vessels independently arose from the descending branch of lateral circumflex femoral (LCF) source vessel. One-arterial-and-one-venous anastomosis was performed in every case. All flaps were successful without any vascular compromise necessitating re-exploration. The median follow-up time was 11.1 months (range, 10 to 12 months), and all patients were alive at the time of evaluation. Compared with the ALT myocutaneous flap, use of the conjoint flaps for reconstruction of complex head and neck defects has several advantages: (1) easy three-dimensional insetting, (2) better aesthetic appearance, (3) more reliability, (4) design with least effort, and (5) possibly reduced donor site morbidity. The disadvantages include (1) the complicated anatomy of the perforators, (2) the learning-curve requirement for their use, and (3) the occasional need for changing the flap outline, or shifting to double flaps. It was concluded that the conjoint ALT fasciocutaneous and VL muscle free flaps provide a good option for reconstruction of composite and three-dimensional head and neck defects.