Scalp Free Flap Reconstruction Using Anterolateral Thigh Flap Pedicle for Interposition Artery and Vein Grafts

Abstract

We experienced satisfactory outcomes by synchronously transplanting an artery and vein using an anterolateral thigh flap pedicle between the vascular pedicle and recipient vessel of a flap for scalp reconstruction. A 45-year-old man developed a subdural hemorrhage due to a fall injury. In this patient, the right temporal cranium was missing and the patient had 4×3 cm and 6×5 cm scalp defects. We planned a scalp reconstruction using a latissimus dorsi free flap. Intraoperatively, there was a severe injury to the right superficial temporal vessel because of previous neurosurgical operations. A 15 cm long pedicle defect was needed to reach the recipient facial vessels. For the vascular graft, the descending branch of the lateral circumflex femoral artery and two venae comitantes were harvested.The flap survived well and the skin graft was successful with no notable complications. When an interposition graft is needed in the reconstruction of the head and neck region for which mobility is mandatory to a greater extent, a sufficient length of graft from an anterolateral flap pedicle could easily be harvested. Thus, this could contribute to not only resolving the disadvantages of a venous graft but also to successfully performing a vascular anastomosis.

Chimeric Anterolateral Thigh Flap in Skull Base Reconstruction: A Case-Based Update and Literature Review

“…On the other hand, Zhao et al [37] documented the flap failure in a traumatic scalp injury 6 weeks after surgery and performed a rescue procedure based on retrograde blood flow of contralateral superficial temporal artery. Park et al [38] considered reconstruction of the cranial profile after traumatic injury with a chimeric ALT flap with no complications by using facial artery and vein in anastomosis. Llorente et al [39] described the use of different free flaps in skull base, including the chimeric ALT flap; the rate of complication for each type of flap and which kind of defect was repaired with chimeric ALT flap was not reported.…”

Immediate Lower Extremity Reconstruction Using an Anterolateral Thigh Free Flap With Simultaneous Interposition Graft of Descending Branches of Lateral Circumflex Femoral Vessels

“…10,11 Several plastic surgeons also used it as an interposition graft in scalp and lower extremity reconstruction. 12,13 Despite anatomic inconstancy, the anterolateral thigh free flap is relatively easy to harvest and utilize. Except for the case of 9.1% in which the perforators originate only from a transverse branch of the lateral femoral circumflex artery, 14 its pedicle can be used to bridge a vascular defect in the extremity.…”

“…10,11 Several plastic surgeons also used it as an interposition graft in scalp and lower extremity reconstruction. 12,13…”

Modification of pedicle lengthening through perforator transposition in free anterolateral thigh flaps with pedicle size discrepancy: A case report

“…Emergency situations, such as rare vascular variations, intravascular thrombosis, and vessel injury during dissection, can be perplexing. Vein grafting is the most commonly used method when such situations arise, but it causes additional donor site morbidity (Park et al, ). Lee et al suggested selection of the most distal perforator, eccentric flap placement, and proximal de‐epithelisation in ALT flaps (Lee, Chen, Chou, & Shieh, ).…”