Surgical Management of Marjolin Ulcer With the Anterolateral Thigh Free Flap

A Retrospective Analysis

Bo Huang, MD; Jian Feng, MD; Houli Luo, MD; Gang Xue, MD, PhD Yanbiao Zhang; Xi Huang; Shuang You; Juncheng Li, MD; Xianhui Li, MD, PhD


Wounds. 2023;35(3):E107-E112. 

In This Article

Abstract and Introduction


Introduction: MU is an aggressive entity, and extended surgical resection is the primary treatment. The defects from an MU extended resection need repair using free flaps, of which the ALT free flap is the most common.

Objective: This study described the feasibility and application value of the ALT free flap in repairing defects after MU resection.

Materials and Methods. Fifteen patients with MU had repairs with ALT free flaps and were treated by the authors' unit from June 2015 through June 2021. All defects were repaired with 1 ALT free flap except for 1 case that required 2 flaps.

Results: The average age of the 11 male and 4 female patients was 52 years (range, 36–71 years). Defect sizes ranged from 8 cm × 5.5 cm to 21 cm × 13.5 cm (mean size, 10.9 cm × 6.5 cm). Flap sizes ranged from 10 cm × 7.5 cm to 23 cm × 15.5 cm (mean size, 12.9 cm × 8.5 cm). All flaps survived completely except for 1 flap in which re-exploration was needed.

Conclusions: The individualized ALT free flap may be selected based on the receiving area characteristics and has certain clinical application value in defect repair after MU resection.


MU is a malignant degeneration of traumatized skin that mostly occurs on a scar and clinically manifests as a local chronic ulcer. The pathology of MU is most commonly squamous cell carcinoma; a few cases of basal cell carcinoma and malignant melanoma have also been reported.[1] Extensive resection of the lesion by surgery has been the first choice for MU. It is more common in the lower limbs (43.7%), followed by the head, neck, upper limbs, trunk, and other regions.[2] Because the scar is relatively dense and lacks elasticity, it is often difficult to suture the scar directly after extended resection of the MU. Free skin grafts can be used to repair the postoperative wound of the MU in nonfunctional parts and without deep tissue exposure after extended resection. Smaller functional parts or wounds with exposed deep tissues can be repaired with pedicled flaps. Most patients do not recognize the early presentation of MU, which leads to late treatment, larger tissue defects, and deeper tissue exposure after extended surgical resection; consequently, free skin flaps are usually required for repair. The ALT free flap has been the most frequently used among the various free flaps, but few reports have described its use to repair wounds after resection of an MU.

This report analyzed the clinical data of patients with MUs that were repaired with ALT free flaps after expanded consultation through a single-center, nonrandomized, retrospective study. The purpose of this study, which, to the authors' knowledge, represents the largest series of ALT free flaps to repair defects, was to provide evidence supporting a viable repair method for clinicians after extensive resection of MUs.