The ALT chimera flap: expanding the indications

The anterolateral thigh (ALT) perforator flap has become one of the major workhorses in reconstructive surgery because of its reliability and low donor site morbidity. However, the indications for this flap are limited when underlying cavities need to be filled or a separate bulk of muscular tissue is needed. To overcome these setbacks, an adipocutaneous-muscle ALT chimera flap with a muscular appendage supplied by a separate branchlet of the perforator pedicle is a useful tool. This work describes the surgical procedure and shows the results of 15 patients with a chimera ALT flap in a series of 88 patients with ALT flaps. Patients with defects after trauma (n = 8), cavities after tumour resection (n = 5) or patients with fasciitis (n = 2) were considered for an ALT chimera flap. A separate vessel for the muscular appendage was found in all 15 cases and the chimera flap could be raised successfully. Filling the underlying cavities and smooth cutaneous defect coverage was possible in all cases. No flap failure was seen (failure rate 5.6% in the whole series), but two patients required microsurgical revisions. Other complications were similar to regular ALT flap procedures. Only one patient developed a complication possibly related to including the muscular component (donor site haematoma). A separate muscular appendage added to the classical ALT flap allows an expansion of the indications of a flap well known for its low complication rate and versatility in reconstructive surgery.