Ipsilateral distal third femoral shaft fracture and retrograde intramedullary fixation are not absolute contraindications to anterolateral thigh flap harvest: A case report

Despite the advantages of anterolateral thigh (ALT) flaps, many surgeons are hesitant to choose a thigh with ipsilateral femoral fracture and internal fixation as the flap donor site. To cover the right mid-upper leg wound, a free ALT flap was harvested from the left thigh of a 55-year-old man who initially underwent closed retrograde intramedullary fixation for a left distal third femoral shaft fracture. The flap was based on a musculocutaneous perforator located in the mid-thigh, which was approximately 10 cm above the proximal fracture level. No adhesion or scar formation between the fascia and adipose tissue was noted when the flap was raised suprafascially, and the adipose tissue surrounding the trunk of the descending branch of the lateral circumflex femoral artery was found to have mild edema. The patient regained good aesthetic outcomes and a complete range of active motion in both lower extremities. Based on current evidence of the vascular anatomy of the ALT flap in the literature and our experience, an ipsilateral thigh with distal third femoral shaft fracture and closed retrograde intramedullary fixation should not be considered an absolute contraindication to ALT flap harvesting.