[Background]
Head and neck cancer (HNC) reconstruction can be difficult when a patient needs another free flap after a prior microsurgical procedure. Moreover, when the ALT flap has already been harvested, it is not easy to choose a sequential flap. The lower medial thigh perforator flap (LMTP) is based on the superficial femoral artery and is published as a reliable free flap. In this study, we describe the use of the LMTP flap for recurrent head and neck cancer, and the LMTP flap was harvested from the thigh of the previous ALT flap.
[Materials and Methods]
This retrospective study included recurrent HNC patients who underwent LMTP flap reconstruction after sequential free flap between 2016 and 2023 in our institution. The LMTP flap was harvested from the ipsilateral thigh, where the ALT flap had already been used. The study recorded parameters of tumor location and stage, size and pedicle length of the LMTP flap, choice of recipient vessels, donor site closure, and postoperative complications.
[Result]
A total of eleven patients underwent the procedure, with one patient experiencing venous congestion of the flap which was salvaged with a vein graft re-anastomosis. All flaps survived without any further complications. The most considerable flap size was 20 X 7cm. One patient required a skin graft for donor site closure, while the remaining ten donor sites were closed primarily. Notably, no significant donor site complications were observed.
[Conclusions]
The lower medial thigh perforator flap is a useful alternative for a sequential flap in HNC cancers. It can be safely harvested from the thigh in which the ALT flap was previously harvested.

Download