Chimeric Anterolateral Thigh Perforator Flaps for Reconstruction of Wound Defects With Dead Space: A Retrospective Comparative Study.

Abstract

Reconstruction of wound defects with associated dead space requires adequate obliteration using well-vascularized tissue to reduce fluid accumulation and support infection control. Conventional musculocutaneous flaps are commonly used for this purpose, but may have limited flexibility in positioning the muscle component. This study evaluated the clinical utility of a chimeric pattern anterolateral thigh (ALT) flap with independently mobile skin and muscle components. Between May 2016 and January 2024, 49 patients underwent reconstruction of wound defects with dead space using free or pedicled ALT flaps. Of these, 26 cases were reconstructed with the conventional musculocutaneous flap, employing the classic en bloc technique. The remaining 23 cases utilized a chimeric pattern perforator flap, consisting of separate skin and muscle components. The skin flap served to resurface the skin defect, while the independently mobile muscle flap was tailored to fill the dead space. Postoperative infection occurred in 3 of 26 patients in the conventional flap group and in none of the chimeric flap group, although the difference was not statistically significant. Both techniques achieved stable wound coverage. The chimeric flap allowed independent positioning of the muscle component according to the location and configuration of the dead space. The chimeric pattern ALT flap offers greater technical flexibility by allowing independent positioning of the skin and muscle components. This technique may facilitate reconstruction of wound defects with eccentrically located or deep dead spaces. Despite the limitations of this study, these findings suggest a potential technical advantage rather than superiority over conventional musculocutaneous ALT flaps.