Arch Hand Microsurg.  2022 Dec;27(4):354-358. 10.12790/ahm.22.0040.

Functional reconstruction of total defects of the dorsiflexor muscles with a chimeric anterolateral thigh free flap: a case report

  • 1Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
  • 2Department of Plastic and Reconstructive Surgery, Cheongju Micro Hospital, Cheongju, Korea


Although several studies exist on the simple volume filling of soft tissue defects in lower extremity reconstruction, few reports have described functional reconstruction. In this study, a 52-year-old male patient, after a forklift accident, developed soft tissue defects of the all the right dorsiflexors. The patient underwent surgery with a chimeric anterolateral thigh free flap (cALT-FF), in which 18×8 cm2 fasciocutaneous flaps were harvested, including a 6×9 cm2 vastus lateralis muscle flap in a chimeric pattern. The functionality of the lower extremities was evaluated in terms of the active ankle-dorsiflexion range of motion and the Stanmore system after 15 months, and the result was good. In this study, we focused on functional reconstruction following the use of cALT-FF in a patient with defects of all the dorsiflexor muscles, which play an important functional role in gait.


Free tissue flaps; Lower extremity; Reconstructive surgical procedures; Recovery of function


  • Fig. 1. Preoperative computed tomography image. Coronal view of a computed tomography image showing a 3.5-cm anterior compartment muscle defect of the right lower limb (bone grafting was performed later through orthopedic surgery for the tibia defect).

  • Fig. 2. Intraoperative clinical images. (A) Design of a vastus lateralis (VL) chimeric anterolateral thigh free flap (cALT-FF). (B) Harvested VL cALT-FF. (C) Clinical photograph revealing a 6-cm-long composite soft tissue defect with plate exposure, after the debridement. (D) An immediate postoperative photograph after the flap was inset.

  • Fig. 3. Scheme of the surgery. (a) This preoperative image represents a 6-cm muscle and soft tissue defect with plate exposure after the debridement. (b) On the other side (left) of the thighs, the chimeric anterolateral thigh free flap (cALT-FF) that had a vastus lateralis (VL) muscle component was harvested. (c) The fasciocutaneous component of the flap restored the soft tissue defect with plate exposure, and the VL muscle component was adjusted to suit the size of the muscle defect.

  • Fig. 4. Postoperative ankle-dorsiflexion range of motion (ROM). The angle of ankle-dorsiflexion ROM improved from –22° before surgery (A) to 0° 15 months after surgery (B).



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