Application of Huge Bipedicle Anterolateral Thigh Free Flaps for Reconstructing Extensive Soft-Tissue Defects.

[BACKGROUND] The anterolateral thigh free flap is widely utilized for reconstructing complex wounds. Despite considerable advances in free flap procedures, partial flap loss remains a challenge, particularly with larger perforator flaps. This study explored the outcomes of bipedicle anterolateral thigh free flap procedures by comparing single-pedicle free flaps in cases involving larger flaps.

[METHODS] This retrospective study included 70 patients who underwent procedures (N = 72) involving extremely large anterolateral thigh free flaps (≥240 cm 2 in area and >30 cm in length) at our hospital between January 2020 and December 2024. Patient characteristics and medical records were comprehensively reviewed, focusing on variables such as age, sex, flap size, surgical technique, perioperative characteristics, and postoperative outcomes.

[RESULTS] A comparison of patient demographics revealed no statistically significant differences across the entire group. A total of 8 bipedicle anterolateral thigh free flap reconstruction procedures were performed. No flap complications were observed in patients undergoing bipedicle free flap reconstruction; this outcome differed significantly from that noted in patients undergoing single-pedicle free flap reconstruction ( P = 0.0215). Besides, no significant between-procedure difference was observed in ischemic time, operative time, or donor site complications.

[CONCLUSIONS] The bipedicle anterolateral thigh free flap procedure appears to be a reliable approach for reconstructing extensive soft tissue defects with a single, substantial flap.