Delayed Anterolateral Thigh Free Flap Reconstruction for Extensive Buccal-Midfacial Necrosis Caused by Invasive Aspergillosis After Pediatric PBSCT: A 7-Year Follow-Up

Acute invasive fungal rhinosinusitis in immunocompromised children may rapidly progress beyond the sinonasal cavity and produce extensive facial and intraoral necrosis. We report an 11-year-old girl with acute myeloblastic leukemia who underwent haploidentical peripheral blood stem cell transplantation (PBSCT) and developed invasive Aspergillus infection involving the right cheek and oral cavity during profound neutropenia. Despite aggressive antimicrobial therapy, serial extirpative procedures, including endoscopic sinus surgery, turbinectomy, maxillectomy, parotidectomy, tracheostomy, and wide cheek debridement, were required. After infection control and wound stabilization, delayed reconstruction was performed with an anterolateral thigh (ALT) free flap. The flap survived without vascular compromise. At 7-year follow-up, the patient remained in complete remission, tolerated a regular diet, had no drooling or salivary fistula, and maintained functionally intelligible speech.