Free Tensor Fascia Lata Perforator Flap: An Alternative Lateral Thigh-Based Option for Head and Neck Oncologic Defect Reconstruction.

[OBJECTIVE] Free tissue transfer is standard in head and neck reconstruction, with the thigh serving as a primary donor site. Contemporary evidence specifically addressing the tensor fascia lata perforator (TFLp) flap, particularly as an immediate alternative when anterolateral thigh (ALT) perforators are absent or unreliable, remains limited. This study aimed to evaluate the TFLp flap as a reliable lateral thigh-based backup option and clinical relevance.

[METHODS] A retrospective study was conducted on 20 patients with oral cancer who underwent microsurgical reconstruction of head and neck defects using TFLp flaps, based on data collected from 957 thigh-based flap reconstructions over 5 years from 2019 to 2023. All TFLp flaps were harvested in cases without visible or sizable perforator of the ALT flap during dissection at the same donor thigh region. Patient demographics, clinical characteristics, flap dimensions, perforator characteristics, and surgical outcomes were retrospectively reviewed and analyzed.

[RESULTS] The harvested TFLp flaps ranged in size from 6 × 4 cm to 20 × 13 cm. Sixty percent of the musculocutaneous perforators required intramuscular dissection, while 40% were septocutaneous. Most flaps (70%) included a single perforator, whereas (30%) had two or more perforators. The overall flap success rate was 95%, with 19 out of 20 flaps surviving successfully. Complications occurred in five patients (25%), including two cases of vascular complications, two hematomas, and one infection. Four of these complications were successfully salvaged. Complications were observed in patients with higher BMI (p-value = 0.0049) and hypertension (p-value = 0.032).

[CONCLUSION] The TFLp flap is an effective alternative lateral thigh-based option in cases in which the ALT flap could not be used for complex head and neck reconstructions.