Introduction The closure of large defects poses a challenge for reconstructive microsurgeons. Although the ALT flap has gained popularity, its size may be insufficient to reconstruct large or complex wounds. We present our experience with free style thigh perforator flaps that incorporate the skin territories of the ALT plus those supplied by the medial vascular system.

Methods and Materials Four patients with complex defects from ablative oncologic surgery for upper extremity, scalp and oropharyngeal tumors were reconstructed using thigh free flaps with larger dimensions or more complex designs than the classic ALT can accommodate. 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 All flaps survived. All donor sites healed and all patients ambulated during their first post-operative week.

Conclusion Free style free flaps incorporating medial thigh perforators used alone or combined with the lateral system expand the repertoire of available thigh flaps. 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.