The use of the ALT Flap and Lateral Femoral Cutaneous Nerve for the Reconstruction of Carpal Soft Tissue and Ulnar Nerve Defects: a Case Report

Abstract

The anterolateral thigh (ALT) flap has become one of the workhorse flaps, with indications including diverse reconstructive problems. The lateral thigh area is also a useful donor site for nerve grafts. The lateral femoral cutaneous (LFC) nerve can be dissected along with the ALT flap for a substantial length, depending on the requirements of the recipient site. The LFC nerve can be used as a vascularized or non-vascularized nerve graft. The technique offers advantages and it can find clinical applications, satisfying the functional and aesthetic reconstructive requirements of a complex defect. We report the case of a patient who presented with traumatic soft tissue defect of the volar aspect of the wrist and ulnar nerve defect as a complication of a fracture of distal radius. An ALT flap was used to reconstruct the soft tissue defect. The ulnar nerve was resected due to necrosis and the gap was repaired with non-vascularized grafts of the anterior branch of the LFC nerve. The soft tissues were resurfaced successfully without complications. Functional recovery was good for the superficial branch of the ulnar nerve, whereas it was variable for the deep branch of the ulnar nerve. The anterolateral thigh area offers significant advantages as donor site in the reconstruction of complex soft tissue defects being a large source of vascularized skin, fat, fascia, muscle and nerve. This availability allows for single donor site dissection, minimizing the operating time and the associated morbidity.

Free anterolateral thigh full-thickness skin flap with vascularized lateral femoral cutaneous nerve for the reconstruction of facial nerve and external auditory canal after the resection of facial nerve schwannoma

“…Combined nerve and soft tissue reconstruction using a free ALT flap with the LFCN has been reported. [5][6][7] Yamamoto et al 5 reported a case using a free ALT flap with vascularized LFCN for treatment of recurrent carpal tunnel syndrome with severe pain due to large neuroma. Villarreal et al 7 reported a case using an extended free ALT flap with vascularized LFCN for the reconstruction of complex neck, head and facial nerve defects following total parotidectomy.…”

Reconstrucción con colgajo anterolateral del muslo en un paciente con indicación de amputación infracondílea

“…lateral en el muslo ha permitido, como opción reconstructiva, el desarrollo de los colgajos del músculo tensor de la fascia lata y del colgajo anterolateral del muslo. 1,2 Este colgajo anterolateral se compone de piel y tejido adiposo subcutáneo de la cara anterolateral del muslo, el cual puede proporcionar una extensa área cutánea cuyas dimensiones varían de 25 a 35 cm; además, se puede lograr un colgajo sensitivo al incluir el nervio cutáneo femoral lateral (L2 y L3), conocido también como nervio cutáneo lateral del muslo o nervio femorocutáneo, que sigue un trayecto oblicuo hacia la espina iliaca anterosuperior que pasa en la profundidad del ligamento inguinal hacia el muslo, dividiéndose en los ramos anterior y posterior. 3 Los ramos anteriores emergen a la superficie en un punto situado aproximadamente 10 cm distal al ligamento inguinal e inervan la piel de las porciones lateral y anterior del muslo.…”