Abstract: Objective    To summarize the clinical results and experience of combined transplantation of bilateral free anterolateral thigh myocutaneous flaps to repair large full-thickness chest wall defects after radical resection of tumor.    Methods    From January 2011 to December 2018, 22 patients who needed full-thickness chest wall reconstruction by using using bilateral femoral anterolateral free myocutaneous flap combined with titanium alloy scaffold or bone cement were admitted to our unit. The area of chest wall defect ranged from 300 cm2 to 700 cm2 (median area was 360 cm2). A total of 44 myocutaneous flaps were designed and harvested, with skin area of (173.55±67.78) cm2 and muscle area of (158.68±94.93) cm2. The flaps were transferred to the chest wall defect, and the arteries were anastomosed in end-to-end manner. According to the number of available arteries in the recipient area, the arterial blood supply of the two musculocutaneous flaps was reconstructed by outer-supercharging or inner-supercharging. During venous anastomosis, different anastomosis strategies were adopted according to the number and pattern of different veins in the vascular pedicle and recipient area.  Results   All 44 myocutaneous flaps from 22 patients survived, while 1 myocutaneous flap had partial necrosis at the distal end, and the wound healed after debridement. All 44 wounds at the donor sites of bilateral thighs healed smoothly, leaving only linear scars. Patients were followed up for 6 to 36 months (18.27±8.62 months), and no local recurrence was found. Bone metastasis was found in one breast cancer patient. The texture of the reconstructed chest wall was good, the patient's breathing was normal, the muscle strength and joint activity of both lower limbs were not affected, and the patient's satisfaction was high.   Conclusions   The combined transplantation of bilateral free anterolateral thigh myocutaneous flaps can cover the chest wall defects well. At the same time, according to the different vascular anatomy, the myocutaneous flaps can protect the function of the donor site to the greatest extent, which is a reliable method for chest wall reconstruction.

Key words: Anterolateral thigh myocutaneous flap,  ,  , Descending branch of lateral circumflex femoral artery,  ,  , Vascular anastomosis,  ,  , Chest wall repair