Clinical application of single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot

Abstract

Objective To explore the clinical efficacy of single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot. Methods From January 2014 to March 2018, 18 patients with dorsal skin and tendon defects of hand and foot were repaired with single or bilobed free anterolateral thigh flaps with fascia lata, including 14 cases of dorsal hand wound and 4 cases of dorsal foot wound. Among them, 1 case was accompanied with 1 tendon defect, 5 cases with 2 tendon defects, 8 cases with 3 tendon defects, 3 cases with 4 tendon defects, and 1 case with 5 tendon defects. There were 12 cases of single lobed flaps and 6 cases of bilobed flaps. 6 cases underwent secondary flap plastic surgery and tenolysis after operation. Results All the 18 flaps survived and the wound achieved primary healing. The donor site of thigh healed well with only linear scar. The follow-up period was 6 to 24 months with an average of 13 months. 14 cases of dorsal skin defects in hand were evaluated according to the criteria issued by the Hand Surgery Society of the Chinese Medical Association with the results being excellent in 6 cases, good in 7 cases, poor in 1 case. 4 cases of dorsal skin defects in foot had good functional recovery, no toe droop and no limitation of walking function. The appearance and texture of the flaps were excellent in 11 cases. No re-rupture or adhesion of extensor tendon occurred. 6 cases underwent second operation to thin the skin flaps 3 months after operation because of unsatisfactory shape. 4 of them had tendon adhesion after hand wound repair. The tenolysis was performed at the same time of skin flaps thinning. The appearance and function of the flaps recovered satisfactorily. Conclusion The single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot have little damage to donor site. It is an ideal method for repairing such injuries for good recovery of hand and foot function. Key words: Surgical flaps; Treatment outcome; Fascia lata; Skin defects; Tendon defects