Background: Free tissue transfer has undergone substantial
improvement over the past three decades, focusing on functional
and aesthetic results of reconstruction for both the
donor and recipient sites. The free ALT flap is atypical example
of this revolution from its early description by Song et al., in
1984 and its later popularization and wide use to reconstruct
defects all over the body from the head to toes yielding very
good functional and aesthetic results with relatively minimal
donor site morbidity making it a workhorse free flap. For
limb reconstruction, it provides a good size of many tissue
types including skin, subcutaneous fat, muscle, and fascia
with possible sensate flap and flow-through flap for limb
revascularization. The flap pedicle is of adequate size and
length, 2 team approach is possible, and donor site morbidity
is minimal especially with direct closure.
Patients and Methods: From April 2016 – December
2018, 11 male patients aged 5-41 years (mean 27.5 years)
with extremity defects including 6 upper limbs and 5 lower
limbs defects were reconstructed using free ALT flap. Defects
were caused by RTA (8 cases), electrical burn (1 case), and
release of contractures (2 cases).
Results: All flaps survived completely except one case
suffered slowly progressive congestion ending in partial flap < br />loss, managed by debridement and skin grafting. Except for
one flap harvested as musculocutaneous, all flaps were fasciocutaneous.
Flaps perforator pattern were musculocutaneous
in 81.9% of cases and septocutaneous in 18.1% of cases. 9
flaps were based on a single perforator, 2 and 3 perforators
each vascularized one flap.
Conclusion: Free ALT flap is a reliable, versatile reconstructive
option for small to moderately large limb defects.
Donor site morbidity is minimal with direct closure.