Functional reconstruction in large and complex soft tissue defects of forearm and hand with multifunctional anterolateral thigh flap

Objectives: The aim of this study was to evaluate the results of free anterolateral thigh (ALT) flap reconstruction for large and complex soft tissue defects of forearm and hand. Patients and methods: Thirteen patients (11 males, 2 females; mean age 32.5 years; range 18 to 55 years) underwent free ALT flap reconstruction for forearm and hand defects. The etiology of defects was crush injury in nine patients, tumor excision in two patients, electric burn in one patient, and unstable scar excision in one patient. In five patients a flow through ALT flap was used to reconstruct vascular defects. In tree patients a vascularised fascial ALT flap was used to reconstruct the tendon: defects and in five patients neurosensory ALT flap was used. Patients were followed for 44 +/- 14.6 months. Chen classification was used to evaluate functional outcomes at the end of the postoperative first year. Results: All flaps survived completely in 11 patients. In the other two patients marginal necrosis was observed. These areas with necrosis healed after debridement and daily dressings. The functional results were satisfactory in 11 patients according to Chen classification (6 patients Chen I and 5 patients Chen II) and poor in two patients (Chen III). Conclusion: The anterolateral thigh flap represents an excellent option for covering various complex defects in the forearm and hand. The flap provides a thin, pliable, vascularized tissue for covering the exposed tendons, nerves, bones, and reconstruct deficiencies.