Tensor fascia lata free flap as salvage solution minimizes donor site morbidity in anterolateral thigh free flap failure—decision making algorithm and a case report

This case highlights the importance of intraoperative flexibility when encountering ALT perforator absence. The TFL free flap represents a dependable salvage solution, characterized by more consistent vascular anatomy and minimal additional donor site morbidity. By enabling conversion within the same surgical field, the TFL flap reduces operative time and avoids the drawbacks of a second donor site. Incorporating this strategy into a structured decision-making algorithm enhances reconstructive safety and broadens the armamentarium for complex head and neck reconstruction.