Bilateral anterolateral thigh free flap in a flow-through chimeric pattern for a extensively large defect reconstruction: a case of an elderly patient under spinal-epidural anesthesia

An 83-year-old male patient presented with a Marjolin’s ulcer on his lower leg, which developed 60 years after a bomb blast injury. The lesion was a 24×12-cm2 chronic ulcer located circumferentially around the mid-third lower leg. Considering the patient’s age, vessel status, and the extent of the defect after wide excision, which included a section of the tibia, reconstruction utilizing bilateral anterolateral thigh free flaps in a flow-through pattern under spinal-epidural anesthesia was planned. The operative time was 9 hours, and the patient fully recovered without any complications. The patient was able to walk without any orthosis, and no evidence of recurrence was found during a 3-year postoperative follow-up period.