A Thanksgiving wish has been answered…

Over the Thanksgiving holiday weekend we performed a Anterolateral thigh free flap (i.e. ALT flap) to cover a chronic scalp wound. This wound resulted from an infected prosthetic bone graft that had been previously placed. His most recent issue dealt with a new cerebral spinal fluid (CSF) leak resulting from the bone graft infection that managed to drain through the scalp wound. This wound had multiple attempts at primary closure without success. Now that we were faced with underlying graft infection we felt the best option we could give the patient was a chance at this free flap.

Basically, we mobilized a fasciocutaneous flap from the anterolateral thigh region based on the lateral circumflex femoral artery. This artery provided perforating vessels that give blood supply to the skin and fascia we needed to cover the scalp wound. After the neurosurgery team removed the contaminated bone graft, fix the dural tear and replace another bone graft we fashioned enough skin flap to close the scalp defect. The skin flap’s blood supply was connected to the superficial temporal artery/vein (i.e. portion of scalp’s blood supply) using microsurgical technique. This resulted in excellent wound coverage and a viable flap.

This patient had suffered  multiple attempts to close a chronic scalp wound with less than optimal results. Now he and his family have their Thanksgiving wishes answered and I can give thanks to them for allowing me to learn from his misfortune and experience my first ALT free flap.

Dr. Matthew Blanton

Duke University Plastic Surgery

Advertisement