Most of the venous ulcers will heal with the treatment of primary venous problem. But a few patients will have refractory, recurrent chronic venous ulcers causing inconvenience to the patients in terms of loss of productive working hours. There is no standard method available for treatment of this chronic problem. Our modality of treatment includes wide excision of ulcer, ligation of incompetent perforators and coverage of defect with well vascularized tissue by free tissue transfer. We have analyzed this form of treatment in five patients with satisfactory result.

Introduction:Primary microvascular reconstruction of multiple defects is challenging particularly if it has to be simultaneous. In trauma cases, harvesting two independent free flaps from different sites is very time-consuming and adds to morbidity. To eliminate these disadvantages, we sought to find out a reliable alternative method of harvesting two independent free flaps based on the descending branch of circumflex femoral artery, i.e., one anterolateral thigh (ALT) flap and one rectus femoris muscle flap.Aim:To study the feasibility of transferring two free flaps, i.e., ALT and rectus femoris muscle flap simultaneously from the same thigh for coverage of two different limb defects.Materials and Methods:From 2003 to 2012, five patients with two defects each were managed with a total of ten flaps harvested from five donor sites based on independent pedicles of descending branch of lateral circumflex femoral artery and used to cover severe injuries of extremities. Three cases had both lower limb defects and two cases had one upper limb and one lower limb defect. In each case, one ALT flap and one rectus femoris muscle flap were used for coverage.Results:All reconstructive procedures were completed without any major complications. All flaps survived well. There were no re-explorations and no complications related to donor sites.Conclusion:We conclude that our approach of simultaneous harvest of ALT and rectus femoris muscle from the same thigh offers two flaps for two different defects in terms of economy of donor site and operating time.

Large bone flaps for free transfer can be successfully and safely harvested based on the deep branch of the superior gluteal artery. The anatomy is consistent, the vessels are large, and the complications of this technique are minimal.

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