Using the distal part of vastus lateralis muscle as chimeric anterolateral thigh free flap is a more flexible tool for head and neck reconstruction

The chimeric anterolateral thigh (ALT) free flap with vastus lateralis (VL) has been our workhorse for soft tissue head and neck reconstruction following cancer resection. Using the distal portion of the VL muscle, as part of the chimeric flap, which is based on the descending branch of the lateral circumflex femoral artery and supplied separately from the skin paddle of the flap, has proved to be a more flexible tool for coverage of these extensive and multidimensional defects. The ALT flap has been a reliable soft tissue source and has shown superiority over other flaps for head and neck reconstruction, especially over its main rival, the radial forearm flap. It offers many advantages and in spite of the intramuscular dissection of the perforator(s) being a challenge, having gained substantial experience in raising this flap, we think that the flap can be harvested safely using a careful dissection, refinements of the surgical technique and understanding of the variable anatomy of the thigh region. This flap solves the problems, which are often encountered by the reconstructive surgeon such as the pedicle length, flap inset, and deficiency of recipient vessels. The purpose of this study is to describe the operative technique, the clinical applications, and the advantages of this variation of the chimeric ALT flap.