Introduction: Severe lower extremity trauma is frequently associated with complex soft tissue defects and vascular injuries, which require extensive soft tissue coverage and vascular repair for limb salvage. We evaluate the outcomes and the role of the anterolateral thigh flow-through flap in lower leg trauma with accompanying vascular injuries.
Materials and Methods:
A retrospective review of all lower extremity injuries required a flow-through flap between 2003 and 2022 was performed. Common scenarios encountered for the use of flow-through flaps were analyzed and categorized. Flap outcomes were assessed by vascular re-exploration, partial flap loss, flap failure, and the need for secondary limb amputation.
Results:
Sixteen consecutive anterolateral thigh flow-through flaps were identified. Eleven patients had Gustilo type IIIB (68.8%) and five IIIC (31.2%) open fractures. Four distinct scenarios for one-stage reconstruction of soft tissue and vascular defects were proposed. Ten posterior tibial (62.5%) and six anterior tibial arteries (37.5%) were reconstructed using these flaps. Vein grafts were necessary in three cases (18.8%) to complete the flow-through reconstruction. Four patients (25.0%) received simultaneous arterial and deep venous reconstruction. Three flaps were performed in an emergency setting due to limb ischemia. All flaps survived. Two (12.5%) required re-explorations for salvage. No limb amputations were recorded.
Conclusion:
The flow-through anterolateral thigh flap can be safely considered in carefully selected patients for one-stage simultaneous vascular and soft tissue reconstruction in lower extremity trauma. The anterolateral thigh flap has anatomical advantages that make it our first choice for lower limb reconstruction.