Free Anterolateral Thigh Flap Reconstruction After Excision of Extensive Vascular Malformations in Toddlers: Report of Two Cases

Vascular malformations often become symptomatic during childhood and require multidisciplinary intervention. However, reports of resection followed by free flap reconstruction in pediatric patients remain rare. We report two toddler cases of vascular malformations reconstructed with free anterolateral thigh (ALT) flaps. Case 1 was a 2-year-old boy with a submandibular venous malformation complicated by coagulopathy. After lesion resection with overlying skin (5 × 10 cm), an ALT flap (5.5 × 12 cm) was transferred. The flap artery was interposed with the transected facial artery, and the veins were anastomosed end-to-side to the internal and external jugular veins. The flap survived completely, and coagulation parameters normalized. Case 2 was a 3-year-old boy with a painful forearm ulcer caused by a capillary lymphatic venous malformation. After ulcer debridement (5.5 × 13 cm), the defect was reconstructed with an ALT flap (6 × 14 cm). The flap vessels were anastomosed to the radial artery and its concomitant veins in a flow-through manner. Partial flap necrosis required secondary wound closure, but the ulcer did not recur, and the pain resolved completely. No anastomotic failure or donor-site complications occurred in either case. Extensive resection followed by ALT flap reconstruction is a reliable option for pediatric vascular malformations. Meticulous microvascular techniques and multiple anastomoses may reduce microvascular complications in young patients.