TFL Perforator Flap Complementing and Completing the ALT–AMT Flap Axis

Abstract

Background Anterolateral thigh (ALT) flap is the most common soft tissue flap used for microvascular reconstruction of head and neck. Its harvest is associated with some unpredictability due to variability in perforator characteristics, injury or unfavorable configuration for complex defects. Anteromedial thigh (AMT) flap is an option, but the low incidence and thickness restrict its utility. Tensor fascia lata (TFL) perforator (TFLP) flap is an excellent option to complement ALT. Its perforator is consistent, robust, in vicinity, and lends itself with the ALT perforator.

Methods This study was an analysis of 29 cases with a free flap for head neck reconstruction with an element of TFLP flap from July 2017 to May 2021.

Results All cases were primarily planned for an ALT reconstruction. There was absence of the ALT perforator in 16 cases but a sizable TFL perforator was available. In 13 cases, the complex defect warranted use of both ALT plus TFL in a conjoint (5), chimeric (5), and multiple (3) free flaps manner. Most common perforator location was septocutaneous between the TFL and gluteus medius. There was complete flap loss in two cases and partial necrosis in two. No adjuvant therapy was delayed.

Conclusion TFLP can reliably complement the ALT/AMT axis. Chimeric ALT–TFL can be harvested for large, complex, multicomponent, and multidimensional defects.

Keywords

tensor fascia lata perforator flap - TFL perforator flap - ALT flap - chimeric ALT harvest - chimeric flaps

Authors' Contributions

D.J., B.S., S.M., M.M., V.P., and A.B. performed the surgeries. D.J. and B.S. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. D.J. and B.S. wrote the manuscript. V.K.S. and P.Y. reviewed the manuscript.

Ethics Approval

The study is a retrospective analysis of cases operated by a proven standard procedure and hence no ethical approval was required.

The study was done with adherence to the Declaration of Helsinki protocol. Proper preprocedure consents were taken for surgery, documentation, and research purposes. The study was approved by the Institutional Ethics Committee. Data storage was performed in accordance with good clinical practice guidelines.

Patient Consent

Consent was taken from all patients regarding the inclusion of clinical data and photographs in this study for the purpose of academic and scientific publication.

Publication History

Received: 25 August 2023

Accepted: 21 April 2024

Accepted Manuscript online:
03 May 2024

Article published online:
14 June 2024

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