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.