Salvage of pedicled anterolateral thigh flap for closure of a massive full-thickness abdominal wall defect using modified Perez protocol for chemical leeching—a case report

The aim of this case report is to spotlight the effectiveness of the Perez protocol for chemical leeching in rescuing a large pedicled anterolateral thigh fasciocutaneous flap endangered by diffuse venous congestion. A review of the case file, clinical photographs, radiological, and histopathological studies of the patient was conducted. Venous congestion was detected on the 2nd postoperative day in a 51-year-old woman who had pedicled anterolateral thigh flap coverage of a massive post-tumour resection full-thickness abdominal wall defect. The Perez protocol was initiated immediately and continued for 14 days. A slight modification of the dosage was necessitated by the volume of flap tissue involved. Partial salvage of the flap was achieved by the 14th postoperative day with no visceral exposure. The residual granulation on the flap was resurfaced with a meshed split-thickness skin graft. We affirmed the reliability of Perez's protocol as a reliable guide for managing flap venous congestion.