Reconstruction of a massive facial defect with the pre-expanded free anterolateral thigh flap: A case report

INTRODUCTION AND IMPORTANCE: Massive facial defects remain a reconstructive challenge because of the region's unique character and the limitation of a well-matched donor site. Pre-expanded free anterolateral thigh (ALT) flap provides a good alternative for reconstructing massive skin and soft tissue defects. CASE PRESENTATION: A 21-year-old male patient presented to our department with a massive right facial degloving wound caused by a sharp edged-weapon attack. The patient left the hospital after 3 weeks of wound care, and only came back to us after 2 months with large defects at the nasal, cheek, and upper and lower right lip regions. The procedure of ALT flap expansion surgery was performed for 2 months. The pre-expanded ALT flap was used for reconstruction of the patient's facial defects. Two-year follow-up showed that the flap at the reconstructed area resembled the contour of the nasal tip, facial skin color similarities in the cheeks and lips, and the patient's mouth had normal function. CLINICAL DISCUSSION: The combined pre-expanded and composite ALT free flap techniques allow simultaneous reconstruction of many different anatomic units. Flap debulking helps to improve the nasal contour from the original defect. The lip separation technique and flap debulking procedure help enhance aesthetic reconstructive outcomes of the skin flap. CONCLUSION: The surgical reconstruction using a pre-expanded ALT free flap for the patient with a massive facial defect was safe. In particular, sufficient skin and soft tissue ensured facial aesthetics and oral function for the patient when using this method.