Versatility of Anterolateral Thigh Flap in Dorsal Hand Reconstruction | ||||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
| Article 16, Volume 42, Issue 2, July 2020, Page 311-315 PDF (16.49 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejprs.2018.79717 | ||||
 View on SCiNiTO | ||||
| Author | ||||
| Moustafa S. A. Mekky* | ||||
| The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt | ||||
| Abstract | ||||
| Background: The latest advancement and high success rate of microsurgery cannot be denied. Although, free flaps have a pioneering characteristics among the rest of other options described in literatures for dorsal hand reconstruction; it should be emphasized that Selection of the donor site is very important. Anterolateral thigh flap was used in of head and neck, breast and upper and lower extremities reconstruction [1,2]. In this article the application of this flap for the dorsal hand skin coverage is presented. Material and Methods: Over almost 3 years (June 2013- September 2016), 12 cases that required dorsal hand coverage were reconstructed by ALT flap. There were 11 males and 1 female with age range 8-49 years. Nine cases were post taumatic, and 3 cases were post burn. In all cases dorsal contractures release and adhesiolysis was carried out. Hand defect includes only the dorsum in 8 cases, the dorsum and 1st web space in 1 case, and the dorsum of hand and fingers in 3 cases. The size of flap skin paddle ranged from 5-9cm: 6-14cm (Width: Length) ratio and the number of perforators included in each flap was single perforator in 10 cases and double in 2 cases. There was intercalary extensor tendon loss in 5 cases for them tensor fascia lata was used tendon reconstruction. There was tendon adhesions in 4 cases for them fascia lata was used to wrap around the tendons to prevent radhesions. In 1 case, there was metacarpal loss that was treated by ALT osteocutaneous flap. All flaps donor site was directly closed. Results: Out of the 12 flaps harvested, only 1 flap failed completely secondary to unsalvageable vein thrombosis. Another 2 flaps developed partial flap necrosis, 1 of them left to heal by secondary intention and the other 1 required skin grafting. Flap debulking was required in 2 cases, 1 case in the stage of flap harvest, and the other case in a secondary stage. For TFL tendon reconstructed, they ended up with a very bad tendon excursion and even non functioning tendons. In the cases of tensor fascia lata wrapping an excellent tendon gliding was achieved. In ALT osteocutaneous flap metacarpal reconstructed case, sound bone healing and integration was achieved. Conclusion: Purportedly, the author found in the robust characteristics of the ALT flap a warrant to be one of the best armaments in the reconstructive options of the hand dorsum. | ||||
| Keywords | ||||
| Hand – Dorsum – Reconstruction | ||||
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