Introduction

The closure or coverage of progressively larger defects is a challenge for reconstructive microsurgeons. Although the ALT flap has gained great popularity, its maximal dimensions may be insufficient to meet the reconstructive needs of large or complex wounds. We present our experience with free style thigh perforator flaps which, in addition to the standard ALT territory, incorporate skin territories supplied by the medial vascular system.

Methods and Materials

Four patients with large or complex defects from ablative oncologic surgery for upper extremity, scalp and oropharyngeal tumors were reconstructed using thigh free flaps whose dimensions were larger or design more complex than what the classic ALT could provide. Wounds ranged from 800 cm2 to 1500 cm2. Two flaps incorporated the rectus femoris muscle, one incorporated the TFL muscle and one was a pure fasciocutaneous flap. Recipient beds were closed with skin grafts.

Results

There were no flap losses. All donor sites healed and all patients successfully ambulated during their first post-operative week.

Conclusion

Free style free flaps incorporating medial thigh perforators, which may be used alone or combined with the lateral system, expand the repertoire of flaps available in the thigh. They allow for flaps with a wide variety of shapes and potential skin paddles and can provide both the large surface area and substantial three-dimensional variability frequently required for complex reconstructions.