Free Thin Anterolateral Thigh Adipofascial Flap for Reconstruction of Hand Dorsum Defect

Abstract

There are many flap choices for reconstruction of dorsal hand defect with extensor tendon exposure. Free flap, such as superficial temporal fascia flap or dorsalis pedis flap, is an optional choice because it provides thin, pliable coverage and good gliding surface for extensor tendons. The anterolateral thigh flap is an another alternative, however, thick and bulky of flap lead to unfavorable results. We modified the anterolateral thigh flap with only including adipofascial layer to reconstruct the soft tissue defect of hand dorsum. A 60 year-old of female patient suffered from metastatic Transitional Cell Carcinoma of the bladder. The extravasation of the chemotherapeutic agents led to skin necrosis over her right dorsal hand. We reconstructed the defect of her right dorsal hand by the free thin anterolateral thigh adipofascial flap. The result of the right dorsal hand was satisfactory after 3 months follow-up. The anterolateral thigh adipofascial flap provided vascularized, thin, and gliding coverage. The donor side can be closed primarily. However, it still bears the disadvantages of needing for skin graft and risk of skin graft failure due to fatty necrosis.