Partially failing ALT flap salvaged using its own distal run-off vessel

This case report presents salvage of a partially failing anterolateral thigh flap. A 37-year-old male, a victim of head and neck squamous cell carcinoma, received tumor ablation and a chimeric anterolateral thigh skin and vastus lateralis muscle flap reconstruction. Before ligation of pedicle, both skin and muscle portions had robust blood supply; however, only the vastus lateralis muscular component remained revascularized rather than the skin paddle with some underlying muscle 30 minutes after patent microanastomosis with recipient vessel. The skin paddle flap was then salvaged by perfusion from a new anastomosis between the distal run-off of the pedicle artery and the perforator artery of this skin flap. From this experience, we recommend to preserve longer distal run-off of the pedicle in chimeric anterolateral thigh flap harvest for necessary "self-revascularization" in similar cases.