Combined Anterolateral thigh and Tensor Fasciae Latae flaps: An option for Reconstruction of large Head and Neck defects

Publication date: Available online 26 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ramzey Tursun, Hisham Marwan, J Marshall Green, Fawaz Alotaibi, Andre LeDoux
IntroductionThe advent of microvascular free tissue transfer has supplemented the reconstructive surgeon with an enormous array of treatment options for reconstruction of large head and neck defects. However, when indicated by defect size, the need for more than one flap not only increases surgical complexity but also patient morbidity. The combination of the anterior lateral thigh flap and the tensor facia latae flap (ALT/TFL flap) can be used to reconstruct such complex head and neck defects thereby minimizing any additional morbidity that would be imposed by an additional flap harvest site. The present study reports the utilization of the combined ALT/TFL Flap to reconstruct large and complex head and neck defects.MethodsA retrospective chart review was conducted including all microvascular head and neck reconstructions performed by Maxillofacial Tumor and Reconstructive Surgery Service at the University of Miami/Jackson Health System during the period between 2013-2016. Inclusion criteria for the study were as follows: large head and neck defects, classified as greater than 20m X 10cm, reconstruction with soft tissue flaps utilizing perforating vasculature to both the tensor fascia latae (TFL) and the anterior lateral thigh (ALT) vascular territories. Other study data included disease history, location of the defect, size of the flap, recipient vessels, harvest time, ischemia time, surgical complications, and overall flap survival.ResultsSeven patients were found to meet the inclusion criteria. Five patients were treated for the diagnosis of stage III osteoradionecrosis and two patients were reconstructed in conjunction with ablative surgery for head and neck carcinoma. All 7 patients underwent successful ALT/TFL head and neck reconstructions. There was no partial or total flap failure. One patient had a wound healing complication at the donor site that did not require surgical intervention.ConclusionReconstruction of large head and neck soft tissue defect with a combined ALT/TFL flap is a reliable method with minimal donor site morbidity and no major postoperative complications. This combined flap should be considered when defect sized extends beyond the bounds allowed by the ALT flap alone.



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