Anterolateral Thigh Research Articles

Novel approach of combined endoluminal and external vacuum therapy for wound healing disorders after salvage pharyngeal reconstruction.

Patients with recurrent head and neck carcinoma are considered for salvage surgery if resectability with clear margins is achievable. However, postoperative complications such as wound healing disorders and pharyngocutaneous fistulas remain significant challenges. While various reconstructive surgical techniques exist, supportive vacuum therapy-both external and endoluminal-has been explored as an alternative treatment modality. We present a case report of a 60-year-old male patient with recurrent laryngeal cancer who underwent salvage laryngopharyngectomy following multiple previous surgical procedures and definitive radiochemotherapy. Due to persistent pharyngocutaneous fistula formation despite multiple reconstructions using pectoralis major flaps, an anterolateral thigh flap, and a fasciocutaneous deltopectoral flap, a novel approach combining endopharyngeal and external vacuum therapy was implemented. Over six weeks, with vacuum system changes performed twice weekly, the pharyngocutaneous fistula successfully closed, leading to complete wound healing. This case demonstrates the potential effectiveness of a combined endopharyngeal and external vacuum therapy approach for treating persistent pharyngocutaneous fistulas when conventional surgical options are exhausted. Notably, the patient was able to resume oral food consumption following therapy, highlighting the functional benefits of this novel treatment strategy.

Beneath the Perforators: Unravelling Fascia Lata Intrinsic Vascular Architecture using microfocus X-ray computed tomography.

The fascia lata (FL), a dense connective tissue enveloping the deep structures of the thigh, has served as an avascular scaffold for decades in reconstructive surgeries, but never as a standalone vascularized flap, because its vasculature is only described by perforating vessels coming from the lateral circumflex femoral artery without specific intrinsic vasculature. However, the demand for vascularized tissue replacements requires a thorough understanding of this inherent vascularization. Based on the anterolateral thigh (ALT) flap knowledge, this study explores the detailed quantitative vascular architecture of the FL, from the perspective of using it as a standalone vascularized flap. High-resolution microfocus X-ray computed tomography (microCT) of Angiofil-latex injected flaps allowed us to study the specific fascial distribution of perforators. Dissections of 11 fresh-frozen lower limbs identified the main perforating arterioles. The intrinsic vascular network within the FL tissue was then analyzed using microCT. The study confirmed an average of 2.5±0.5 main perforating trunks giving rise to 5.6±2.9 perforating arterioles per thigh. Notably, microCT revealed a distinct intrinsic vascular network within the FL tissue, with tiny arterioles of 55.39±28.47µm radius and a volumetric density of 33,347,960±23,243,879µm³/mm². This intrinsic vasculature exhibited a high density of bifurcations (branching nodes=1.36±2.26/mm²), demonstrating its potential use as a vascularized flap. This study unveils the intrinsic vascularization of the FL, supporting its utility as a mega-thin vascularized flap in reconstructive surgery. Based on this vascular carrier, these findings also open new applications for tissue engineering and personalized medicine, toward an improvement of surgical outcomes and patient recovery.

Smartphone Thermal Imaging as an Adjunct to Identify Free Flap Perforators and Assisting Flap Design: A Pilot Study.

The main technique for identification of free flap perforator vessels is Doppler sonography, which is not always accurate, user dependent and affected by the patient's body habitus. Adult patients undergoing head and neck resection and free flap reconstruction at two academic institutions were enrolled. Doppler sonography was used to identify perforators, and were marked using a skin marker. The donor site was cooled down for 3 min using a sterile iced saline bag. FLIR-ONE (FLIR Systems Inc., Wilsonville, OR) camera was used to assess for "hot spots" during a 3-5 min period of re-warming as a surrogate for cutaneous blood flow. The distance between the Doppler signal location, and the "hot spot" was recorded. The position of the perforator was then identified intraoperatively and the distances between the surgical position, the Doppler and "hot spot" were recorded. A total of 28 patients were included. For all flap types, FLIR thermal imaging measurements consistently tended to be closer to the surgical site compared to Doppler ultrasound. In anterolateral thigh flaps (n = 20), thoracodorsal artery perforator flaps (n = 5), and fibula osteocutaneous flaps (n = 3), absolute mean differences ranged from 0.62 to 1.33 cm, with trends favoring FLIR. While paired t-tests did not reach statistical significance, both methods correlated with intraoperatively identified skin perforators, and distances generally ranged between 0 and 2 cm. We demonstrate that a smartphone-based thermal imaging system has the potential to serve as an adjunct for identifying flap perforators, with the possibility of reducing operative times and minimizing patient morbidity. Level 3.

A Pilot Trial of Tongue Reconstruction Using the Chimeric Innervated Vastus Lateralis Muscle and Antero-Lateral Thigh Free Flap.

Subtotal and total glossectomies for advanced tongue cancer result in significant speech- and swallow-related morbidity, impairing quality of life. This prospective pilot study compares the safety and functional outcomes associated with using a chimeric innervated muscle and fasciocutaneous flap for soft tissue reconstruction. A prospective, non-randomized controlled pilot study evaluated a standardized technique for tongue reconstruction using a chimeric innervated vastus lateralis muscle and anterolateral thigh fasciocutaneous flap. Inclusion criteria were ≥ 50% resection of the oral tongue. Participants were followed longitudinally, with measures recorded at baseline, 6-8 weeks, 6 months, and 12 months after surgery. The primary endpoints were post-operative complications, time to radiotherapy, operative time, and locoregional failure, videofluoroscopy swallow studies (dynamic imaging grade of swallowing toxicity (DIGEST), penetration and aspiration score, performance status scale for head and neck). Secondary endpoints were patient-rated outcomes. Eighteen participants were recruited (10 intervention: 8 controls). Fourteen (78%) experienced complications, only one of which was related to the innervated flap. DIGEST scores deteriorated post-operatively across all participants but did not differ significantly between the intervention and control groups (p = 0.4) at any point post-surgery, despite more extensive resections in the intervention group. Those in the intervention group had better patient-rated intelligibility (p = 0.04). Multimodality treatment was associated with worse speech (p = 0.03) and normalcy of diet (p = 0.02). Less extensive resections were associated with better scores in eating in public (p = 0.005), tongue range of movement (p = 0.0008), intelligibility (p = 0.006), and diet (p = 0.001). The innervated vastus lateralis and antero-lateral thigh free-flap technique is safe and improves speech intelligibility for patients with subtotal and total glossectomy defects. However, the technique requires refinement to optimize functional and quality-of-life outcomes.

Use of a Pedicled Anterolateral Thigh Flap as Fasciocutaneous and Chimeric With Vastus Lateralis Muscle for Bilateral Trochanteric Radionecrosis Reconstruction: A Case Report

Use of a Pedicled Anterolateral Thigh Flap as Fasciocutaneous and Chimeric With Vastus Lateralis Muscle for Bilateral Trochanteric Radionecrosis Reconstruction: A Case Report

Reconstruction of Advanced Basal Cell Carcinoma of the Face: Case Report

Reconstruction of advanced basal cell carcinoma of the face presents a challenge. Anterolateral thigh free flap (ALTF) and radial forearm free flap (RFFF) are commonly used free flaps for head and neck reconstruction. However, we found ALTF is considerably thicker than that of RFFF. Hence for facial reconstruction following basal cell carcinoma excision, the RFFF is preferred due to its flexibility and cosmetic outcomes.

Continental Preferences in Reconstruction of Pharyngolaryngectomy Defects: A Multi-National Survey.

Reconstruction of total pharyngolaryngectomy defects may restore pharyngeal function and enable tracheoesophageal speech after resection of locoregionally advanced malignancy. Little remains known about variations in the practices and preferences of surgeons across differing global regions. A survey was sent to reconstructive head and neck surgeons across three continents with responses analyzed to evaluate trends. Of 155 respondents, 79.4% (n = 123) completed the survey including surgeons from North America (USA/Canada), the Indian Subcontinent (India/Bangladesh) and Australia/New Zealand. Among surgeons trained in pedicle flap reconstruction, only 47.5% performed these procedures after completion of training. Pedicle flaps were performed most frequently by surgeons from the Indian subcontinent. The anterolateral thigh flap was most popular among surgeons for free flap reconstruction, 58.5% (n = 72). This study demonstrates significant region-based variation in preferred reconstructive modality, suggesting location of practice and institutional experience influence the reconstructive algorithms of head and neck surgeons.

Clinical outcomes of reconstruction on tissue defects with thin anterolateral thigh flap versus commonly used free soft flaps: A meta-analysis.

The thin anterolateral thigh flap (tALTF) is gaining attention in reconstructive surgery due to its aesthetic and functional advantages. However, its clinical safety and outcomes compared to other commonly used free soft flaps (CUFSFs) remain unclear. Studies were systematically searched from PubMed, EMBASE, Medline, Cochrane, Web of Science, and China National Knowledge Infrastructure Database up to November 2, 2024. Flap failure, donor and recipient site morbidity, secondary salvage surgery, and patient satisfaction were evaluated. A total of 416 cases from 7 studies were included in our analysis. No significant difference was observed between the two groups in flap failure and secondary salvage surgery. However, tALTF showed significant advantages over CUFSFs in skin grafting, donor and recipient site morbidity, and patient satisfaction. This meta-analysis highlights the clinical safety and superior outcomes of tALTF compared to CUFSFs in reconstructive surgery, suggesting its viability as a preferred option for surgeons. However, the retrospective design of the included studies and limited sample sizes necessitate further large-scale prospective studies to validate these results.

Versatility of the Anterolateral Thigh Flap for Abdominal Wall Reconstruction.

Abdominal wall reconstruction represents an ambitious and demanding challenge. This study aimed to illustrate the versatility of the anterolateral thigh (ALT) flap in its different designs for the reconstruction of complex defects of the abdominal wall. Charts of patients with complex abdominal wall defects who underwent a reconstruction with an ALT flap at the University Hospital of Zurich (2018-2020) were reviewed retrospectively. Patient characteristics and ALT flaps used were analyzed in detail. Ten patients received a total of 12 ALT flaps. Free flaps were applied to defects in the upper third of the abdomen. All flaps were harvested with a fascial component. An iliotibial tract reinforcement was incorporated in 4 (33%) cases, and 1 case included a muscular component and motor nerve, to provide functional reconstructive potential. A total of 30% of cases experienced complications requiring surgical revision during a mean follow-up of 5 months. The ALT flap represents a workhorse in abdominal wall reconstruction due to its versatility and anatomical proximity. Depending on the localization of the defect, this flap can be used in a pedicled or free microsurgical manner. The fascial component of the ALT fasciocutaneous flap and of the extended iliotibial tract provides stable fascia for reinforcement or fascial reconstruction of the abdominal wall. Raised as a chimeric flap with vastus lateralis muscle and motor branch of the femoral nerve, it is a viable option for functional reconstructions.

Testicular lodges creation during scrotal reconstruction by ALT (anterolateral thigh) island flap after Fournier gangrene: A case report.

Fournier's gangrene is a severe infection of the perineum and genital regions, with high mortality rate. Treatment is medico-surgical and multidisciplinary, usually requiring extensive debridement of scrotal tissue and distant surgical reconstruction. Regarding scrotal reconstruction, numerous techniques have been described, however, to our knowledge, none has focused on testicular repositioning. We present the case of a 47-year-old patient treated for secondary Fournier's gangrene on post-traumatic colic fistula following a road traffic accident. We performed scrotal reconstruction using an ALT flap, with simultaneous positioning of testicular implants to create new lodges. In a second time, the testicular implants were removed and the previously buried testicles were repositioned in their new lodges, with bilateral orchidopexy. The anterolateral thigh flap has already been described for scrotal reconstruction. Its main advantages over a thin skin graft are partial innervation and more convincing aesthetic results, with notably less skin retraction. In addition, it allows a sufficiently large skin palette to be harvested, enabling satisfactory scrotal coverage. Placement of 2 testicular implants during scrotal flap reconstruction after Fournier's gangrene enables the creation of testicular lodges, facilitating subsequent repositioning of previously buried testicles. This technique also ensures a satisfactory aesthetic and functional result.

Preparation of anterolateral thigh flap from polio-affected lower limb: A safe surgical option that preserves patient's motor function.

The anterolateral thigh (ALT) flap is a commonly used donor site for reconstructive surger, especially in head and neck reconstructions. The flap's success is primarily determined by the quality and quantity of its perforating vessels, which is why clinicians typically prefer harvesting from a healthy leg with intact vascular anatomy. Poliomyelitis typically causes unilateral lower limb paralysis, resulting in muscle atrophy and deformities. Harvesting the ALT flap from the paralyzed leg could preserve the function of the unaffected limb, but this approach is complicated by the atrophy and deformities present in the affected leg, creating substantial challenges. We here report the successful ALT flap harvesting from the polio-affected leg in a 55-year-old male patient for the reconstruction of a tongue defect. The patient diagnosed with Left tongue squamous cell carcinoma, and underwent tongue cancer excision and a modified radical neck dissection. The flap survived and healed well with the patient's tongue tissue. The wound at the donor site on the thigh also healed well. There were no complications observed in either the flap or the donor site. Our experience suggests that harvesting from the paralyzed leg is a safe and feasible procedure that preserves the function of the unaffected limb and may enhance the postoperative quality of life for polio survivors.

Saving exposed titanium mesh cranioplasty using adipocutaneous anterolateral thigh flap: A case series

Saving exposed titanium mesh cranioplasty using adipocutaneous anterolateral thigh flap: A case series

Utility of Free Fibula Flap With an Extended Banana-shaped Skin Paddle for Oro-mandibular Reconstructions.

The free fibula flap is a common technique for mandibular bone defects. However, its limited skin paddle is disadvantageous in cases with significant soft-tissue defects. A free fibula dual-skin paddle flap is used for medium-sized soft-tissue defects. Just as the anterolateral thigh flap can be extended through linking vessels, so the peroneal skin flap can be extended to the adjacent proximal area through linking vessels. This has led to the development of the free fibula banana-shaped flap. From 2021 to 2023, 8 patients, with an average age of 68.1 years, underwent head and neck reconstructive surgery using the free fibula banana-shaped flap at the Saitama Cancer Center in Japan. Their primary disease, defect sites, flaps, bone size, and postoperative complications were analyzed retrospectively. The blood flow of the flap was examined using intraoperative indocyanine green imaging. All 8 patients had successful operations with only 1 partial necrosis of the flap tip. Four patients had buccal mucosa cancers, 3 had osteoradionecrosis of the jaw, and 1 had lower gingival cancer. The flap size averaged 25.0 ± 3.0 cm (long axis) and 4.1 ± 0.4 cm (short axis), with a transplanted bone length of 8.4 ± 1.9 cm. The number of perforators was 1-3 in the distal to the central area. All flaps' microcirculation was confirmed with intraoperative indocyanine green imaging; the average time was 3 minutes 59 seconds. Postoperative complications included 1 surgical site infection and 1 minor salivary leak. The free fibula banana-shaped flap is a good option for head and neck reconstructive surgery in medium-sized soft-tissue defects with mandibular bone defects.

“C-shaped” anterolateral thigh flap for stomal repair due to recurrence in patients with total laryngectomy

Background: Stomal recurrence after total laryngectomy is one of the most challenging problems in head and neck surgery due to the complexity of its management. The tracheal opening remains deep and caudal after resection, creating a neo stoma that presenting a significant challenge for reconstructive surgery. With this study, we aimed to describe the design of the C-shaped ALT flap to show that it is the ideal design in such a difficult reconstruction. Methods: Five patients who underwent a free ALT flap for defects in the anterior neck wall and airway after resection due to tumor recurrence adjacent to a permanent stoma between 2018-2020 were included in the study. Tumor resection was performed by the Otolaryngology team in all cases. Age, gender, cause of defect, ALT flap size, donor site closure method, number of perforators, ischemia time, flap survival, early complications, and postoperative tracheostomy use and postoperative quality of life assessment were reviewed. Results: 5 male patients were included in the study and the mean age was 63.8. The mean duration between admission and recurrence after laryngectomy was 11.2 months. Flap survival was noted in all patients. The patients did not encounter complications such as tracheostomy-related dehiscence, discharge, fistula, cannulation difficulties due to flap collapse, and mediastinitis during their lifetime. In the follow-ups, one still alive, the mean survival time of the other three patients was four months. We found an average high score in our patients regarding functional scales in QLQ-H&N35 module. Conclusions: The C-shaped ALT flap design provides ease of insertion into a tension-free tracheal-skin suture line and helps to reduce the rates of stoma-related complications and increase the quality of life of the patients.

The Chimeric Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Infratemporal Fossa Reconstruction in Oral Cancer Defects

The Chimeric Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Infratemporal Fossa Reconstruction in Oral Cancer Defects

Comparing the Versatility of Anterolateral Thigh (ALT) Free Flap and Superficial Circumflex Iliac Artery Perforator (SCIP) Free Flap for Hand Reconstruction Due to Electric Burn Injuries: Case-Based Literature Review

Electrical injuries, often caused by high-voltage currents from sources like arc flashes or ignited clothing, frequently result in extensive burns, particularly to the hands. The upper extremities, being common contact points for electrical injuries, are susceptible to severe tissue damage, including burns, nerve, muscle, and vascular damage. High-voltage electrical burns often require surgical intervention, with an emphasis on restoring both function and form. This study aims to compare the effectiveness of two free flap techniques—Anterolateral Thigh (ALT) and Superficial Circumflex Iliac Artery Perforator (SCIP)—in the reconstruction of hand burns resulting from electrical injuries. Authors conducted a literature review based on cases from the burn unit at Pertamina Central Hospital, Jakarta, focusing on two patients who underwent reconstruction using the ALT and SCIP free flaps. The ALT free flap, characterized by its versatile and reliable tissue coverage, was utilized in one case, while the SCIP free flap, known for its thin and pliable tissue, was employed in the other. The study reviews the anatomy, advantages, and limitations of each flap, considering factors such as functional outcomes, aesthetic results, donor site morbidity, and surgical complexity. Both techniques were shown to offer significant benefits in reconstructing complex burn injuries, with the ALT flap providing robust coverage and the SCIP flap offering superior contour and functional outcomes for smaller defects. The findings underscore the versatility of both flaps in electrical burn reconstruction, highlighting the importance of choosing the appropriate technique based on the size and location of the defect. This study contributes valuable insights into the selection of free flap techniques for reconstructing hand injuries caused by electrical burns, aiming to optimize patient outcomes in terms of both functionality and aesthetics.

Chimeric Free Flaps Based on End-to-Side Anastomosis for Complex Lower Extremity Reconstruction.

Complex lower extremity defects are difficult to cover and often require multiple free tissue transfers. Chimeric anterolateral thigh free flaps (ALTF) and peroneal artery perforator free flaps (PAPF) have been designed specifically as an alternative for reconstruction with arterial end-to-side (ETS) anastomosis. We aimed to assess our institutional experience with this technique and to define its role in complex lower extremity reconstruction. From July 2012 to March 2023, 27 patients with complex lower extremity defects underwent reconstruction with chimeric ALTF or PAPF. Patients were performed with retrograde flaps for repairing refractory wounds of tibia plateau fracture and antegrade flaps for distal 2/3 tibia and beyond. Demographic, clinical, and follow-up data on the patients were recorded with a special focus on complication profiles during a follow-up of 6 to 60 months. The mean defect size measured 121.1 ± 215.1 cm2, and the chimeric ALTF or PAPF flaps measured 143.9 ± 177.8 cm2. One patient lost the first free flap but successfully had a chimeric PAPF then. Three patients suffered partial free flap loss, and another 3 had minor complications. All 6 survived after an additional exploration, wound dressing, or antibiotics treatment. The retrograde flaps achieved similar blood flow to the antegrade flaps. Patients are all satisfied with functional and aesthetic outcomes. Given the incidence of complications, utilizing chimeric ALTF and PAPF either with retrograde or antegrade flow based on arterial ETS anastomosis is a reliable surgical option for complex lower extremity reconstructions.

Application of poly ether ether ketone localization marker combined with mixed reality technology in vessel localization of anterolateral thigh perforator flap

To compare the effectiveness of poly ether ether ketone (PEEK) localization marker combined with mixed reality technology versus color doppler ultrasound guidance for the vessel localization of anterolateral thigh perforator flap. A retrospective analysis was conducted on 40 patients with tissue defects after oral cancer resection who underwent repair using the anterolateral thigh perforator flap between January 2022 and June 2023. According to the different intraoperative positioning methods of the anterolateral thigh perforator flap, they were randomly divided into PEEK group [using PEEK localization marker combined with mixed reality technology based on CT angiography (CTA) data] and color ultrasound group (using color ultrasound guidance), with 20 cases in each group. There was no significant difference in gender, age, etiology, and disease duration between the two groups ( P>0.05). The number of perforator vessels identified in the two groups of regions of interest was recorded, and compared them with the intraoperative actually detected number to calculate the success identifying rate of perforator vessels; the distance between the perforating point and the actual puncture point was measured, the operation time of the two groups of flaps was recorded. In the PEEK group, 32 perforator vessels were identified, 34 were detected by intraoperative exploration, and the success identifying rate was 94.1% (32/34); in the color ultrasound group, 29 perforator vessels were identified, 33 were detected by intraoperative exploration, and the success identifying rate was 87.8% (29/33); there was a significant difference in the success identifying rate between the two groups ( P<0.05). The distance between the perforating point and the actual puncture point and the operation time in PEEK group were significantly shorter than those in color ultrasound group ( P<0.05). Patients in both groups were followed up 6-30 months, with a median of 17 months; there was no significant difference in follow-up time between the two groups ( P>0.05). In the PEEK group, there was 1 case of flap necrosis at the distal edge and delayed healing after trimming and dressing change. In the color ultrasound group, there was 1 case of flap necrosis at 7 days after operation and pectoralis major myocutaneous flap was selected for repair after removal of the necrotic flap. In the rest, the flap survived and the incision healed by first intention. Donor site infection occurred in 1 case in PEEK group and healed after anti-inflammatory treatment. The maxillofacial appearance of the two groups was good, the flap was not obviously bloated, and the patients were satisfied with the repair effect. Compared with the traditional color ultrasound guidance, the PEEK localization marker combined with mixed reality technology based on CTA data in vessel localization of anterolateral thigh perforator flap has higher success identifying rate and positioning accuracy, and the flap production time is shorter, which has high clinical application value.

Pharmacokinetics of the Monoclonal Antibody, Sotrovimab, in Healthy Participants Following IM Administration at Different Injection Sites.

Sotrovimab is a recombinant human monoclonal antibody for the early treatment of mild-to-moderate COVID- 19. A phase I, open-label, randomized, parallel-group study was conducted to investigate the pharmacokinetics, relative bioavailability, safety, and tolerability of two concentrations of sotrovimab administered intramuscularly at different injection sites in healthy volunteers. The study consisted of three parts (A, B, and C) and the pharmacokinetic results from Part A are reported herein. In Part A, participants were randomized in a 2:2:1:1 ratio to a 500 mg dose of 62.5 mg/mL sotrovimab administered into dorsogluteal muscle, or 100 mg/mL sotrovimab administered into dorsogluteal, anterolateral thigh, or deltoid muscles. Formulation concentration did not impact exposure following dorsogluteal administration; the point estimates (90% confidence interval [CI]) of the geometric mean ratios (GMRs) of area under the curve (AUC)inf and maximum serum concentration (Cmax) for dorsogluteal administration of 100 mg/mL vs. 62.5 mg/mL intramuscular sotrovimab were 0.95 (0.86-1.05) and 1.14 (1.02-1.27), respectively. However, the administration of 100 mg/mL sotrovimab in thigh or deltoid resulted in increased exposure relative to gluteal injections; the point estimates (90% CI) of the GMRs for 100 mg/mL intramuscular sotrovimab administered into thigh or deltoid muscles vs. 100 mg/mL administered dorsogluteally were 1.63 (1.46-1.83) and 1.50 (1.34-1.67) for AUCinf, and 1.82 (1.60-2.08) and 1.49 (1.31-1.69) for Cmax, respectively. Notably, thigh and deltoid administration also resulted in lower variability in key pharmacokinetic parameters such as AUC, Cmax, apparent clearance and volume of distribution, and earlier achievement of Cmax, than dorsogluteal intramuscular administration of sotrovimab.

Free Vascularized Dermofat Flap For Contouring Maxilla In Fibrous Dysplasia Patients

Fibrous dysplasia is a disease that causes bone thinning and growth of lesions in one or more bones and leads to bone weakness and scar formation within the bones. Especially when involving the skull or facial bones, the lesions can cause externally visible deformities. We reported one case of fibrous dysplasia of the maxilla reconstructed in our Plastic Surgery Division of Cipto Mangunkusumo Hospital. Data was taken from the medical and surgery records. In this case, we used the Antero Lateral Thigh (ALT) flap to reconstruct the maxilla and facial contour in 26 years old girl with fibrous dysplasia. After the operation we had daily observation to evaluate the blood flow to the flap and it had satisfactory result without any complication. Ultimately, free vascularized dermofat flap with ALT seems to be suitable for craniofacial contouring surgery, in this case for contouring maxilla. Facial contour could further be improved after secondary reshaping of the healed flaps. This led to nearly perfect long-term facial symmetry in all cases. The ALT proved to be a reliable donor site, providing enough well-vascularized fatty tissue for facial contour augmentation.