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Patients with severe injury or vasculopathy of the extremities often require resurfacing of tissue defects as well as preservation of functional blood flow to distal areas. In conventional free flap transfer, the recipient vessel is sacrificed to facilitate pedicle anastomosis. On the other hand, a flow‐through flap can provide blood flow to distal tissues. In this chapter, we present cases of successful salvage and reconstruction of the extremities using free flow‐through flaps and highlight their advantages and applications. Free flow‐through flap use should be a good option in the following cases: (1) Gustilo‐ Anderson IIIC type open fracture, (2) chronic ulcer resurfacing in the less vascularized extremities, and (3) additional blood supply for an ischemic flap. This flap facilitates not only the reconstruction of soft tissue defects, but also restores the functional vascular anatomy and maintains the original blood flow by interposing the T‐portion of the ves‐ sel. This technique enables both vascular and soft tissue reconstructions simultaneously with minimal donor site problems. The anterolateral thigh flap is recommended as a free flow‐through‐type flap due to its advantages, including the variety of flap sizes, adequate calibers of the vascular pedicle, and the lack of a need for position changing.

Application of Free Flow‐Through Anterolateral Thigh Flap for the Reconstruction of an Extremity Soft Tissue Defect Requiring Vascularization