Single stage traumatic paediatric scalp defect reconstruction with free chimeric anterolateral thigh and vastus lateralis muscle flap – a case report

Introduction Reconstruction of scalp defects is challenging for plastic surgeons as retaining functionality and achieving excellent cosmesis is essential. Various extensions of the anterolateral thigh (ALT) flap led to the introduction of chimeric flaps that are of immense benefit in complex reconstruction, especially in paediatric patients with favorable outcomes. Aim The delicate nature of paediatric patients and the minuscule anatomy warrant an effectual reconstruction method encompassing adequate soft tissue and bony coverage and acceptable cosmetic results due to the obvious scalp visibility. Case study We present a case of a 3-year-old boy who presented with a degloving left temporoparietal scalp wound with exposed parietal bone following a motor vehicle accident that necessitated immediate soft tissue coverage after wound bed preparation. Results and discussion The advancement in microsurgery has led to the development of various chimeric pattern flaps, which in our case utilizes free tissue transfer using free chimeric fasciocutaneous ALT flap and vastus lateralis muscle flap. By employing different tissue flaps with a long pedicle coming from the same vascular source, it gives more flexibility in complex reconstruction while avoiding donor site morbidity. Conclusions Free tissue transfer using free chimeric fasciocutaneous ALT flap and vastus lateralis muscle flap provides a single-stage reconstruction with sufficient tissue coverage and superior aesthetic outcomes.