Salvage of Finger Length in Septicemic Necrosis Using 3 Free Flaps From a Single Anterolateral Thigh Donor Site

Abstract

Severe septicemic necrosis can result in extremely debilitating morbidity for patients, often resulting in 4-limb amputation. Further operative procedures to improve both function and cosmesis can be fraught with complexity and complications. The ideal aim in such patients would be to maintain sufficient length and provide soft tissue cover in a single 1-step procedure. We present a novel case in which twin free flaps were used acutely to provide 3 separate skin paddles to cover 2 hand stumps from a single anterolateral thigh donor site, thus maintaining the optimum digit length for subsequent function. We believe that this is the first reported case of using 3 separate flaps from 1 single anterolateral thigh donor site to resurface and salvage digit length in both hands following septicemic necrosis. Detailed knowledge of the anatomy of the anterolateral thigh flap and an understanding of the perforator flap concept can allow others to further develop the many and versatile uses of this flap.

Reconstruction of two separate defects in the upper extremity using anterolateral thigh chimeric flap

“…Localization and course of perforators can be determined accurately and vascular anomalies can be identified . Once perforators are identified, variations in skin paddle design allow for multiple skin paddle configurations, central or eccentric orientations, and custom‐made flaps tailored to fit almost any defect …”

“…9 Once perforators are identified, variations in skin paddle design allow for multiple skin paddle configurations, central or eccentric orientations, and custom-made flaps tailored to fit almost any defect. 10,11 A disadvantage of the ALT chimeric flap design technique is that this technique is skill demanded. The course of perforators may be unpredictable, and the small and long perforators may be difficult to harvest and inset.…”