Algorithm for salvage of the devascularised upper extremity, with associated soft tissue defect, using the anterolateral thigh free flap

Author(s): Hari Venkatramani1, S Raja Sabapathy2, Vishwamitra B Dayal3

Mutilating upper limb soft tissue defects in the presence of critical ischaemia pose a unique challenge to the reconstructive surgeon. Vascular compromise may not only dictate the time frame in which reconstruction must take place, but also limit available reconstructive options. Salvage of upper extremity injuries is rightly more aggressive than similar injury patterns in lower limb injuries. Functional reconstruction of the upper limb leads to far better outcomes than with a prosthesis while aiming to preserve “the highly desirable facility of tactile sensation”. In 1983, the concept of flow-through free flaps was first suggested by Souter, for reconstruction of head and neck defects. In 1991, Costa et al. described the single stage resurfacing and revascularization of two traumatized limbs with a flow-through radial forearm free flap. A recent series by Aggarwal et al. reported the exclusive use of flow-through free Antero Lateral Thigh (ALT) flaps in the salvage of devascularised upper and lower limb injuries.