Pedicle Anterolateral Thigh Flap Reconstruction after Pelvic Tumor Resection: A Case Report

A 47-year-old female with a locally advanced urologic malignancy previously managed with resection, diversion, and postoperative radiation therapy presented for management of her recurrent cancer that had eroded through the soft tissues of the left inner thigh and vulva. On all staging studies the tumor involved the left common femoral artery, and vein, both above and below the inguinal ligament. The difficulty with such tumors is the availability of tissue to reconstruct the defect. The patient had a history of deep venous thrombosis in the femoral venous system. A local flap was the most logical type of reconstruction. The patient had a right lower quadrant ureterostomy with a large parastomal hernia which further limited the local flap options. An anterolateral thigh flap from the opposite thigh was used to reconstruct the soft tissue deficit in this patient. This resurfaced the defect and provided coverage for the vascular reconstruction. 1. Background Options are limited for soft tissue reconstruction after tumor removal in the inguinal region. Once the lower extremity has been made ischemic for tumor removal the options for local flap reconstruction are limited. Here a case is presented for the use of a contralateral local flap after tumor removal and prosthetic vascular reconstruction. 2. Case Presentation A 47-year-old female presented with a large foul smelling wound of the left inguinal region with severe pain with ambulation. She had been treated with radiation therapy for a locally aggressive urologic malignancy with not distant metastasis. A surgical plan that involved resection of the tumor, femoral artery, and vein with immediate reconstruction of the vessels and soft tissues was designed for this patient. The abdomen would not be a donor site given her ureterostomy on the right and tumor involvement of both the femoral arterial and venous bifurcations on the left. The patient underwent resection of the tumor and immediate reconstruction of the femoral artery and vein with heparin-bonded PTFE grafts (Propaten, W.L. Gore, Inc., Flagstaff, AZ) [1]. Once flow had been established to the left lower extremity, the resulting soft tissue deficit was evaluated. An 8 c m × 1 5 c m soft tissue defect in the inguinal region had to be reconstructed. Given the fact that the patient had a history of deep venous thrombosis, resection of the gracilis with the tumor, and reconstruction of the femoral artery and vein from just below the iliac bifurcations to the midthigh we chose to use the anterolateral thigh flap from the opposite extremity. Other flaps