Use of Pedicled Anterolateral Thigh Flap in Revascularized Profunda Femoris Artery Following Long-term Occlusion

Groin wound complications following vascular surgery affect up to 40% of patients, potentially necessitating complex flap reconstruction. One of the reconstruction flaps is the pedicled anterolateral thigh flap, supplied by the descending branch of the lateral circumflex femoral artery from the profunda femoris artery. Although flap reconstruction is well documented, the use of revascularized pedicles, particularly after long-term occlusion, remains unexplored in the current literature. We present a case in which a pedicled anterolateral thigh of a profunda femoris artery proximal to the lateral circumflex femoral artery was raised and then successfully inset in a delayed fashion. This is the first report of revascularization of an occluded major artery proximal to the branch supplying a flap and using that flap for reconstruction. This unprecedented approach demonstrates both the viability of revascularized pedicles and the potential for successful reconstruction using flaps supplied by previously compromised vessels. This case expands the possibilities for complex wound reconstruction in patients with compromised vasculature and establishes a foundation for future applications of this technique.