Hang ZHANG, Feifei ZHANG, Fujun ZENG, Jie DIAO, Yuchuan LIU, Guohua JIANG, Linjun TANG, Yaping LIU
Acta Orthopaedica et Traumatologica Turcica - 2026;60(3):1-6
Objective: The objective of this study was to investigate the efficiency of reconstructing large upper extremity defects using a flow-through anterolateral thigh (ALT) flap anastomosed to a superficial circumflex iliac artery (SCIA) flap. Methods: Between January 2020 and January 2023, 22 patients (22 upper limbs) with large upper extremity soft-tissue defects were treated using this technique. Long defects, defined by a length-to-width ratio greater than 1.5:1 and involving both the forearm and hand, were included. Short defects amenable to local or pedicled flaps, as well as those associated with active infection, were excluded. Preoperative computed tomography angiography was performed in all patients. All procedures were performed by the same 2 microsurgical teams. Demographic data, flap dimensions, pedicle length, and postoperative outcomes were recorded. Results: The mean defect size was 22.3 x 9.2 cm (range, 15.7 x 7.5 to 28.4 x 12.3 cm). The mean ALT flap size was 16.7 x 11.1 cm (range, 11 x 8 to 21 x 14.1 cm) with a mean pedicle length of 7.9 cm (range, 5.2-11.8 cm). The mean SCIA flap size was 8.7 cm x 6.1 cm (6.3 cm x 5.1 cm to 11.3 cm x 7.5 cm) with a mean pedicle length of 5.4 cm (range, 3.8-7.4 cm). All flaps survived completely. The mean follow-up period was 27.8 months (range, 25-32 months). The mean pain scores at the recipient and donor sites were 1.2 cm (range, 0-3 cm) and 0.8 cm (range, 0-2 cm), respectively. Mild cold intolerance occurred in 20 patients and moderate intolerance in 2. The mean aesthetic satisfaction score was 8.1 cm (range, 6-10 cm), and the mean overall patient satisfaction was 8.4 cm (range, 7-10 cm). Conclusion: Reconstruction of extensive upper extremity defects can be effectively achieved using the flow-through ALT flap anastomosed to the SCIA flap. This method provides reliable vascularity, satisfactory aesthetic and functional outcomes, and minimal donor site morbidity, representing a safe and effective option for complex limb reconstruction.
