Reconstruction with Anterolateral Thigh Free Flap in Rwanda: A Case Series

BACKGROUND: The anterolateral thigh (ALT) free flap is a good flap for reconstructing both lower limb and head and neck defects. It has a reliable vascular pedicle —the descending branch of the lateral circumflex femoral artery. Its minimal donor site morbidity makes it an excellent choice for reconstruction in various anatomical areas. The aim of this study is to share our experience using the free ALT flap to cover lower limb, head, and neck defects. METHODS: Case 1: A 33-year-old female presented three weeks after a road traffic accident in which she sustained an exposed open fracture of the left tibia and fibula. She underwent multiple debridements followed by reconstruction with a free ALT flap. Case 2: A 55-year-old female presented with a three-year history of right-sided scalp lesions, with a biopsy revealing basal cell carcinoma. After excision, she underwent ALT free flap for scalp defect coverage. RESULTS: Both cases demonstrated good outcomes. Neither patient required return to the operating room for flap salvage, and there were no instances of surgical site infection or tip necrosis. However, both patients reported postoperative bulkiness of the flaps, which will necessitate flap defatting. CONCLUSION: The ALT flap is a workhorse for covering defects of the leg, head, and neck. It is the preferred flap in institutions with microsurgical expertise, as its use has been shown to reduce lower limb amputation rates. Despite having a limited number of microsurgeons, Rwanda is making efforts to address this gap through trainings.