Reconstruction of Hand using Anterolateral Thigh Fascial Free Flap

ABSTRACT

PURPOSE: The provision of thin and pliable tissue and the adequate coverage of tendon-gliding surface is necessary for a soft tissue defect of the hand with exposure of bone, tendon and muscle. This report discusses our experience with anterolateral thigh fascial free flap for the reconstruction of the soft tissue defect of the hand. METHODS: From February 2004 to August 2008, seven patients with full-thickness soft tissue defects in the hand were reconstructed by means of a composite anterolateral thigh fascial free flap. There were soft tissue defects associated with trauma(n=5), scar contracture(n=1) and necrosis due to ischemia(n=1). The flaps were harvested from the anterolateral thigh as adipofascial flaps with only a small sheet of fascia and fatty tissue above it. The fascia and the skin of the donor site was closed directly and delayed split-thickness skin graft was performed. RESULTS: All flaps survived completely. The size of the transferred flap ranged from 2x4cm to 5x8cm. Thin flap coverage was possible without secondary debulking operations. It left minimal donor site morbidity with a linear scar. In one case, the thigh muscle herniation in the donor site was developed. CONCLUSION: The anterolateral thigh fascial free flap provided thin and pliable tissue which can establish a tendon-gliding mechanism, minimal bulk and minimal donor site morbidity. The disadvantages of this technique were the needs for a skin graft and the muscle herniation in donor site.