The use of the anterolateral thigh vascular free flap in complex open elbow fractures after major trauma - An illustrated report of an interesting case

Reconstruction of upper extremity soft tissue defects with free flaps

Aim: Many methods have been described in the literature for the reconstruction of upper extremity defects that may occur as a result of various etiological reasons. Among these methods, local or regional flaps are used quite frequently, and most defects can be successfully reconstructed. However, in some large and complex defects, technically more difficult free flap options may be unavoidable. In our study, we present our experience on upper extremity reconstruction with free flaps. Materials and Methods: Between 2015 and 2021, 9 patients (3 Female, 6 Male) underwent upper extremity reconstructions with free flaps. The ages of the patients ranged from 22 to 68 years. Our free flap choices included anterolateral thigh flap in 4 patients, latissimus dorsi free flap in 4 patients, and radial forearm free flap in 1 patient. Defects of patients were including dorsum of the hand in 3 patients, an amputation stump in 1 patient, the dorsum of the hand with the forearm in 2 patients, and the elbow with the forearm in 3 patients. Results: The radial artery was chosen as the recipient artery in all patients. The concomitant vein of the radial artery or the superficial venous system was used as the recipient vein. End-to-end anastomosis was performed in 6 patients and end-to-side anastomosis was performed in 3 patients. Arterial thrombosis was observed in 1 patient and venous thrombosis was observed in 1 patient. All vascular complications occurred in reconstructions with latissimus dorsi free flaps. Both patients were taken to early salvage surgery, the anastomoses were renewed and the flaps were salvaged. No additional complications were observed in other patients. There was no flap loss in our clinical series. Conclusion: Free flaps can be used safely for upper extremity soft tissue reconstructions in appropriate cases. Although it requires technical experience, we believe that perforator-based free flaps are quite advantageous due to minimal donor site problems and can be safely chosen as the first method in suitable patients.