Abstract
Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and February 2016. Antero-lateral thigh flaps were performed to cover post traumatic upper limb soft tissue defects. Brachial interposition grafts were used in all cases. Harvesting was performed using saphenous vein graft. A 10% larger than defect, flap was used to cover defect. Results: The age range was 15 to 46 years. All 15 cases were male. The indication for soft tissue reconstruction was trauma all patients. Each procedure was performed by a “two team” approach with an experienced surgeon raising the flap and a team preparing the recipient vessels. Flap size ranged from 15 to 25 cm in length and from 8 to 10 cm in width. Ischaemic time ranged from 91 to 157 min. We experienced a 100% flap success rate, with good cosmesis and return to function in all cases. Only two anastomoses required explorations or revision. Minor complications were seen in two patients including a superficial wound infection and a small wound dehiscence. The donor site was closed directly all cases, light dressing with slab support was utilized in all patients Early postoperative management warming the patient, half-hourly flap observations, and ensuring adequate hydration and urinary output. All patients received antithrombotic therapy. Conclusion: The anterolateral thigh flap is one of the most versatile and useful perforator flaps for multidimensional reconstructions for head and neck, limb, trunk, and perineal region. It can be ultrathin flap for resurfacing and filling dead spaces with superior functional and aesthetic outcomes.
Highlights
The antero-lateral thigh flap was first introduced by Song et al in 1984 as a septo-cutaneous flap based on musculo-cutaneous and septo-cutaneous perforators of descending branch of lateral circumflex femoral artery [1]
Complex defects are caused by traumatic injury to upper extremity and they require urgent coverage with flap
The antero-lateral thigh flap is based on the descending branch of the lateral circumflex femoral artery which passes through the intermuscular septum between the rectus femoris and vastus lateralis
Summary
The antero-lateral thigh flap was first introduced by Song et al in 1984 as a septo-cutaneous flap based on musculo-cutaneous and septo-cutaneous perforators of descending branch of lateral circumflex femoral artery [1]. Large skin paddle, versatility and acceptable morbity have resulted in its success. It requires two teams’ approach, so it saves time which would have been wasted in repositioning of patient if only one team would be operating on patient. Complex defects are caused by traumatic injury to upper extremity and they require urgent coverage with flap. In this paper we utilized anterolateral thigh flap in coverage of post traumatic upper limb defects
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