Introduction
Radical tumor ablations in the head and neck region require intricate reconstructive procedures. This challenge is amplified in patients with HIV, where more advanced disease is often observed at presentation, resulting in poorer outcomes and increased complications. Free tissue transfer has greatly enhanced the ability to preserve function and aesthetics while adhering to oncologic surgery principles. The anterolateral thigh (ALT) flap has become a reliable workhorse in this regard.

Case Report
We present the case of a 51-year-old HIV-positive male with oral squamous cell carcinoma. The tumor was resected, and the resultant defect was reconstructed using a free, sensate, chimeric anterolateral thigh (ALT) flap. The patient underwent close follow-up, which included intensive free flap monitoring in the immediate postoperative period and subsequent routine clinical reviews.

Outcome
At the six-week postoperative review, the patient demonstrated a healthy, well-incorporated flap that successfully resurfaced both the intraoral and cutaneous defects. Sensory restoration was achieved using the lateral femoral cutaneous nerve, which is particularly useful in managing complex through-and-through cheek defects after oncologic surgery.

Conclusion
A chimeric ALT flap is an excellent reconstructive option for resurfacing both intraoral and cutaneous defects following radical head and neck tumor ablation. Its ability to restore both form and sensation makes it especially valuable in complex cases, including those involving HIV-positive patients.