Versatile Use of the Free Anterolateral Thigh Flap in Pediatric Reconstruction: A Report of Two Cases

Abstract

Complex soft tissue defects in children require reconstructive solutions that are stable, adaptable, and compatible with long-term growth. The free anterolateral thigh flap offers several advantages in this setting because it can be tailored according to the defect, either as a durable resurfacing flap or as a source of vascularized tissue volume. We report two pediatric cases managed with a free anterolateral thigh flap for different reconstructive purposes. The first patient was an eight-year-old boy with a painful and unstable post-traumatic scar of the right heel after a road traffic accident and previous split-thickness skin grafting. After complete scar excision, reconstruction was performed using an ipsilateral fasciocutaneous anterolateral thigh flap. At two-year follow-up, the flap remained stable, painless, and free of ulceration; the visual analog scale pain score decreased from 6/10 preoperatively to 0/10, and the patient resumed school activities, walked independently with definitive adapted footwear, and required no secondary debulking procedure. The second patient was a seven-year-old boy with xeroderma pigmentosum who presented with a large nasal squamous cell carcinoma extending to the upper lip and pre-nasal cheek region. After tumor excision with 1 cm lateral margins, resection through a healthy deep plane, and bilateral cervical lymph node dissection, reconstruction was achieved using a free fasciocutaneous anterolateral thigh flap harvested from the left thigh. The cervical lymph node dissection was negative, and no adjuvant radiotherapy was administered after multidisciplinary tumor board discussion because complete excision had been achieved and the benefit-risk balance was considered unfavorable in the context of xeroderma pigmentosum. At one-year clinical follow-up, there was no evidence of recurrence. These two cases illustrate how the free anterolateral thigh flap may address different pediatric reconstructive needs, ranging from durable heel coverage to vascularized filling of a central facial cavity after oncologic resection.