Can anterolateral thigh flap be a rescuer in lower extremity injuries?

[OBJECTIVE] The lower extremity contains a variety of functional structures therefore re-establishing soft tissue coverage in large-scale injuries is a challenging procedure. Microsurgery has made progress in reducing donor morbidity and achieving a functional and aesthetic appearance in recent years. This study aimed to apply anterolateral thigh (ALT) flap to tissue defects in the lower extremity and to discuss the results.

[PATIENTS AND METHODS] Twenty-three patients who were admitted to our hospital with lower extremity trauma and underwent ALT flap surgery due to soft tissue defect between November 2020 and March 2022 were included in the study. Patients' demographic data, the applied surgical procedure, the development of postoperative complications, and postoperative functional results were evaluated.

[RESULTS] Twenty-three patients were included in this research. The mean age of the patients was 36.56±14.67 (10-61). Of these patients, 3 were female (13%), and 20 were male (87%). The most common etiology was traffic accident (n=8, 34%), followed by gunshot injuries (n=5, 21%), electrical burn (n=4, 17%), open fractures (n=2, 7%), infection (n=2, 7%), diabetic foot (n=1, 4%), skin tumor (n=1, 4%). Flaps were raised from the contralateral extremity in twelve patients (52%) and on the ipsilateral extremity in eleven patients (48%). The average time from first trauma to free flap surgery was 10.7±5 days (4-22). The average postoperative hospitalization was 13.6 days (9-23 days). The average follow-up time of patients was 8 months (3-13 months). The donor site is closed with primary saturation in 19 patients (82%) and closed with split-thickness skin grafting in 4 patients (18%). Our overall success rate was 96%. We had only one total flap failure out of twenty-three patients (4%).

[CONCLUSIONS] ALT-free flap is an excellent choice for reconstructing lower extremity complex defects. For experienced surgeons, the ALT flap can be used successfully in the treatment of soft tissue defects of variable size in the lower extremity.