Lower extremity injuries requiring soft tissue coverage comprises a significant proportion of these injuries worldwide. Reconstruction of the soft tissues overlying fractures is essential for bone union and reduction of infection thus improving function and reducing the rate of limb amputation. The advantage of free tissue transfer has provided multiple options for complex defects of the lower extremities that maintain the functional and aesthetic status of the limb. Since the first report of the ALT flap by Song et al. in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft tissue defects because it has a large cutaneous area and a long vascular pedicle with a suitable vessel diameter with acceptable donor site morbidity. Also, flap thickness can be adjusted and can be combined with neighboring muscles when additional bulkiness is needed. The operation can be carried out by 2 teams working simultaneously.
Participants and Methods
A prospective study was carried out on 25 patients with clinical diagnosis of complex soft tissue defects in distal third leg and foot; Patients were divided into two groups who underwent Fasciocutaneous ALT (15 patients-group I) and Cutaneous ALT (10 patients-group II), to compare between both groups in many aspects including patient demographics, complication rates, aesthetic and functional outcomes of donor and recipient sites, hospitalization period and patient satisfaction.
Operative duration was significantly higher in group II (408 min) compared to group I (348 min). As regard recipient site complications including congestion and partial flap necrosis were higher in group I (13.3%) for each compared to group II (0%), but total flap necrosis, infection and hematoma, there were no significant differences between both groups. There were significant differences between both groups as regard donor site functional outcome including sensory disturbance and cold intolerance were higher in group I (46.7%) than group II. As regard Contour defect and flap bulkiness were significantly higher in group I (20% & 40%) respectively compared to group II (0%)
In our experience, we found that the free ALT perforator flap offers a variety of tissues available from a single donor site as an excellent option for reconstruction of large and complex soft tissue defects in the lower extremities with perfect functional and aesthetic results that can be achieved through elevating Cutaneous ALT Free flap to avoid sensory disturbance of the donor site and secondary surgical debulking after Fasciocutaneous ALT Free flap.