Single stage soft tissue and extensor tendon reconstruction of upper extremity with antero-lateral thigh free flap- A case report

Abstract

Soft tissue coverage for traumatic soft tissue loss of upper extremity is challenging with limited local tissues availability. Hence, free tissue transfer is indicated. A patient presented to us with degloving injury of the right dorsum hand and forearm following a road traffic accident. There was large soft tissue defect on the dorsal lateral aspect of the hand and forearm, open comminuted fracture of the distal end of the radius with segmental loss of extensor tendons. After adequate debridement and fracture stabilization with external fixator, soft tissue and extensor tendon reconstruction were performed with conjoined flow-through anterior-lateral thigh and tensor fascia lata free flap. At postoperative three months, there was non union of the distal end of right radius. Flap was re-elevated and non union was corrected with osteotomy, non vascularized bone graft and locking plate. Subsequently, at 1 year follow up revealed limited range of movement at wrist joint (flexion-extension 15 degree), acceptable at metacarpophalangeal of all fingers (hyperextension 15 degree, flexion 60 degree) and interphalangeal joints (PIP joint extension-flexion 0-45 degree, DIP joint extension-flexion 0-15 degree). Hand grip was weak and requires further hand therapy. Anterior lateral thigh flap is a versatile and reliable option for reconstruction of large soft tissue and composite defects of upper extremity with favourable outcome.