Reconstruction of extensive craniofacial defect following paraganglioma excision using a chimeric anterolateral thigh flap: a case report

Extended radical excision of aggressive tumors, such as the carotid paraganglioma involving the ethmoid, maxillary and intracranial spaces, results in massive composite craniofacial defects. Successful reconstruction requires simultaneously achieving effective dead space refilling and creating a stable anophthalmic orbital socket. This report highlights the utility of the chimeric anterolateral thigh (ALT) flap in addressing this reconstructive challenge. A 28-year-old man presented with a complex craniofacial defect following the wide excision of an extensive carotid paraganglioma. A chimeric ALT musculocutaneous flap (22 × 10 cm) was harvested, containing two independent skin paddles and a part of the vastus lateralis muscle. One musculocutaneous flap (8 × 14 cm) was de-epithelialized to augment the dead space after total maxillectomy and orbital exenteration. The fasciocutaneous flap (6 × 8 cm) was thinned and molded into a double-layer flap, which was rolled into a socket configuration for orbital reconstruction. Microvascular anastomosis was performed end-to-end to the facial vessels. Intraoperatively, perfusion of all flap components was excellent. The flap remained well perfused postoperatively without congestion or ischemia. At the 25-month follow-up, the patient demonstrated stable healing, a well-contoured midface profile, and adequate socket depth for prosthetic fitting. The chimeric ALT flap offers a highly reliable and versatile solution for the complex reconstruction of massive composite craniofacial defects following extensive tumor resection. This chimeric approach effectively meets the simultaneous requirements for dead-space obliteration and stable orbital socket formation using a single donor site.