LAUSR

is determined and performed in one stage rather than requiring a subsequent surgery and intra-flap pedicle dissection as we report. Haddock et al. describe a single-stage double-free flow-through reconstruction for a complex scalp defect, utilizing an ALT flap with the lateral circumflex femoral artery as a large calibre flowthrough vessel to allow for end-to-end anastomosis with the thoracodorsal artery supplying a large LD flap. The LD flap is commonly used as a flow-through flap in extremity reconstruction, and has also been used effectively in scalp reconstruction in a series of seven single-stage cases. While these utilize the principles of flow through, they differ from our case as delicate dissection of the RFFF pedicle that had been previously used to reconstruct the scalp was not required. This case highlights the importance of considering a flowthrough flap reconstruction in a scalp defect with limited recipient vessel options. This technique should be considered as part of the reconstructive armamentarium for those managing complex serially reconstructed tissue defects.