Case Series of Anterolateral Thigh Free Flap Reconstruction in Rwanda

Background: The anterolateral thigh free flap is a versatile reconstructive option for lower limb and head and neck defects. It provides a large skin paddle with a reliable vascular pedicle—the descending branch of the lateral circumflex femoral artery—and is ideal for covering complex soft tissue defects. Its minimal donor site morbidity, along with the option to include muscle or fascia, makes it a versatile choice for reconstruction of various anatomical sites. Methods: All 3 patients included in this case series were selected after assessing that their defects could not be covered with local flaps. A detailed history was obtained for each patient, including smoking status, diabetes, and other vascular diseases, along with any prior radiotherapy. Computed tomography angiography was performed for every patient to confirm that the recipient vessels are patent, along with the standard preoperative workup. Results: The 3 patients who presented, 1 for a scalp basal cell carcinoma defect postexcision and 2 with left leg defect for coverage of exposed and fractured left tibia following trauma, demonstrated good clinical outcomes. None of the patients required a return to the operating room for microvascular compromise, and there were no instances of flap necrosis, or congestion. However, all patients reported postoperative flap fullness, which may necessitate flap debulking in the future. Conclusions: This case series is not intended to draw definitive conclusions regarding the use of the free anterolateral thigh flap, but rather, the cases are presented to illustrate local microsurgical capacity made possible through international collaboration.