Sequential chimeric anterolateral thigh flap for reconstruction of through-and-through oropharyngeal defects with no suitable neck recipient vessels.

The anterolateral thigh flap is currently the frontline choice for head and neck reconstruction. The authors used a chimeric anterolateral thigh flap for reconstruction of a through-and-through oropharyngeal defect. Because of the absence of suitable recipient vessels in the proximity of the defect, the authors recruited the internal mammary vessels. To gain extra pedicle length, the authors converted the chimeric anterolateral thigh flap into a sequential iatrogenic chimeric anterolateral thigh flap. This new flap concept consists essentially of the division of the skin paddle of the anterolateral thigh that is based on two perforators, and the creation of a sequential chimeric flap by reconnecting the pedicles in the opposite order. A functionally good and aesthetically pleasing result was obtained.