Chimeric anterolateral thigh-vastus lateralis free flap with propeller skin island for functional quadriceps reconstruction.

Introduction: Soft-tissue sarcomas arising in the thigh may require total or subtotal compartmentectomy, with subsequent need for functional reconstruction with free functional muscle transfer (FFMT). We present our series, describing a new approach with chimeric propeller antero-lateral thigh-vastus lateralis (ALT-VL) free flap, which allows for independent muscle inset and soft tissue defect resurfacing. Patient and methods: A retrospective review of a prospectively maintained database was performed, analyzing all patients referred to Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy, between 2018 and 2023 for soft-tissue sarcomas of the thigh requiring wide excision and reconstruction with functional ALT-VL. Cases involving a functional chimeric ALT-VL flap with propeller skin island were reported. Results: Eight patients underwent quadriceps reconstruction with functional ALT-VL. All of them underwent neoadjuvant radiation therapy. Patients' age ranged from 59 to 82 years old (mean 68 years old). Skin defect size ranged from 54.95 cm Conclusion: The free functional chimeric ALT-VL flap with propeller skin island is a valid reconstructive option for complex defects of the anterior compartment of the thigh, especially indicated when functional impairment is associated with wide or transversely-oriented skin defects.