Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(02): 208-210
DOI: 10.1055/s-0041-1730844
Case Report

Chimeric ALT Plus TFL Perforator Flap for Breast Reconstruction Post Radical Mastectomy with Large Skin Defect

Dushyant Jaiswal
1   Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Mayur Raman Mantri
1   Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Vinay Kant Shankhdhar 
1   Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Snehjeet Hemant Wagh
1   Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

A 17-year-old girl with large malignant phyllodes tumor of left breast underwent a radical mastectomy with large skin excision resulting in defect of 20 cm × 18 cm. Postoperative radiation therapy necessitated robust cover with flap. The challenge was compounded by her body habitus. Both abdomen and back were deficient as donor sites and a single-island anterolateral thigh (ALT) flap would need skin grafts, volume deficit withstanding. We harvested chimeric ALT plus tensor fascia lata (TFL) perforator free flap sparing all muscles and nerves. Microvascular anastomoses were done to the second internal mammary artery (IMA) perforator artery and vein. The donor site was closed primarily. The TFL flap territory recruited almost three times the volume of ALT territory and allowed us to create a matching breast mound in addition to covering the defect. She tolerated 40 Gy radiation well and doesn’t desire further augmentation. Consistency of ALT and TFL perforators makes this a replicable procedure.

Keywords

anterolateral thigh flap - tensor fascia lata flap - post mastectomy reconstruction


Publication History

Article published online:
28 June 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 World Health Oragnization. Cancer country profiles 2020—India. https://www.who.int/cancer/country-profiles/IND_2020.pdf?ua=1. Accessed June 1, 2020
  • 2 Billington A, Dayicioglu D, Smith P, Kiluk J. Review of procedures for reconstruction of soft tissue chest wall defects following advanced breast malignancies. Cancer Contr 2019;26(1):1073274819827284
  • 3 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37 (02) 149-159
    CrossrefPubMedGoogle Scholar
  • 4 Jaiswal D, Ghalme A, Yadav P, Shankhdhar V, Deshpande A. Free anteromedial thigh perforator flap: complementing and completing the anterolateral thigh flap. Indian J Plast Surg 2017; 50 (01) 16-20
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Deiler S, Pfadenhauer A, Widmann J, Stutzle H, Kanz K-G, Stock W. Tensor fasciae latae perforator flap for reconstruction of composite Achilles tendon defects with skin and vascularized fascia. Plast Reconstr Surg 2000; 106 (02) 342-349
    CrossrefPubMedGoogle Scholar
  • 6 Contedini F, Negosanti L, Pinto V. et al. Tensor fascia latae perforator flap: an alternative reconstructive choice for anterolateral thigh flap when no sizable skin perforator is available. Indian J Plast Surg 2013; 46 (01) 55-58
    CrossrefPubMedGoogle Scholar
  • 7 Hubmer MG, Schwaiger N, Windisch G. et al. The vascular anatomy of the tensor fasciae latae perforator flap. Plast Reconstr Surg 2009; 124 (01) 181-189
    CrossrefPubMedGoogle Scholar
  • 8 Tuinder SMH, Beugels J, Lataster A. et al. The lateral thigh perforator flap for autologous breast reconstruction: a prospective analysis of 138 flaps. Plast Reconstr Surg 2018; 141 (02) 257-268
    CrossrefPubMedGoogle Scholar
  • 9 Gore SM, Akhavani MA, Kang N, Chana JS. Chest wall reconstruction using a turbocharged chimaeric anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2008; 61 (04) 438-441
    CrossrefPubMedGoogle Scholar
  • 10 Pelzer M, Germann G, Czermak C, Reichenberger M. Combined split ALT/TFL flap for soft tissue coverage in large thoracical defects [in German]. Der Chirurg 2014; 85 (01) 42-45
    CrossrefPubMedGoogle Scholar