Dual Vascular Free Anterolateral Thigh Flap

Area of Science:

• Microsurgery
• Plastic and Reconstructive Surgery
• Head and Neck Oncology

Background:

• The optimal number of microvascular anastomoses for free tissue transfer remains debated.
• While two venous anastomoses are discussed, the benefit of a second arterial anastomosis is underexplored.

Purpose of the Study:

• To investigate the safety and outcomes of using two arterial anastomoses in anterolateral thigh (ALT) free flaps for head and neck cancer reconstruction.

Main Methods:

• Retrospective review of 12 patients undergoing ALT free flap reconstruction with two arterial anastomoses.
• Analysis of flap survival, complications, and vascular patterns.

Main Results:

• All 12 ALT free flaps survived without major vascular compromise.
• Complications included one instance each of venous thrombosis and reexploration, and three instances of leakage.
• Three distinct vascular patterns of dual-arterialized ALT flaps were identified, with similar operative times across types.

Conclusions:

• An additional arterial anastomosis in ALT free flaps did not lead to congestion or disrupt flow balance.
• Dual arterial anastomosis is a potentially safe option for ALT flaps, especially if the primary arterial supply is deemed unreliable.