Use of a Pedicled Anterolateral Thigh Flap as Fasciocutaneous and Chimeric With Vastus Lateralis Muscle for Bilateral Trochanteric Radionecrosis Reconstruction: A Case Report

Pelvic radiation for gynecological malignancies may induce several acute and late complications. Among those, skin and soft tissue radionecrosis at the trochanteric region represents a rare event, associated with significant morbidity. The therapeutic approach for those deep and large trochanteric defects is challenging, requiring a combination of radical debridement of the necrotic tissue and reconstruction using pedicled or free flaps. Accordingly, we present our experience with the use of a pedicled anterolateral thigh flap as fasciocutaneous and chimeric with the vastus lateralis muscle for the reconstruction of a late bilateral trochanteric skin and soft tissue radionecrosis. The wounds were completely healed without evidence of recurrence at the 24-month postoperative follow-up. We emphasize the importance of using well-vascularized and bulky flaps for successful filling and coverage of large post-radiation trochanteric defects to achieve good functional and aesthetic outcomes and to prevent recurrence.