TFL perforator flap – complementing and completing the ALT-AMT flap axis.

Background: Antero-lateral thigh flap (ALT) is the most common soft tissue flap used for microvascular reconstruction of head and neck. Its harvest is associated with some unpredictability due to variability in perforator characteristics, injury or unfavorable configuration for complex defects. Antero-medial thigh flap (AMT) is an option, but the low incidence and thickness restricts its utility. TFL perforator flap (TFLP) is an excellent option to complement ALT. Its perforator is consistent, robust, in vicinity and lends itself with ALT perforator, to large conjoint flap, chimeric designs and possible two free flap harvest from the same thigh. Methods: Analysis of 29 cases with a free flap for head neck reconstruction with an element of TFLP. Results: All cases were primarily planned for an ALT reconstruction. There was absence of the ALT perforator in 16 cases but a sizable TFL perforator was available. In 13 cases the complex defect warranted use of both ALT plus TFL in a conjoint (5), chimeric (5) and multiple (3) free flaps manner. Most common perforator location was septo-cutaneous between the TFL and Gluteus Medius. There was complete flap loss in two cases and partial necrosis in two. No adjuvant therapy was delayed. Conclusion: TFLP can be used to counter ALT/AMT unavailability, injury, suboptimal quality or need of a thicker flap. Chimeric ALT-TFL can be harvested for large, complex, multicomponent and multidimensional defects. We recommend, harvesting flaps from the thigh with a non-committal straight line incision initially, perceiving ALT-AMT-TFL perforators as a unit.