Versatility of Free Adipofascial Anterolateral Thigh Flap in Reconstruction of Traumatic Extremity Injuries: 124 Cases in Colombia, 2017-2023.

BACKGROUND

The free adipofascial anterolateral thigh (ALT) flap is proposed for limb reconstruction because of its thinness; adaptability to complex anatomical contours such as the foot, ankle, and leg; and elimination of debulking procedures. It also reduces donor-site morbidity by allowing primary closure and minimal thigh asymmetry.

METHODS

This retrospective case series included 124 patients who underwent microsurgical limb reconstruction with a free adipofascial ALT flap between 2017 and 2023. In the subsequent cross-sectional follow-up in 2024, 44 of these patients were evaluated using a survey and semistructured interview.

RESULTS

The most common recipient sites were the foot dorsum (42%) and ankle (26%). The flap success rate was 85.5%. Complications included recipient-site infection (11.3%) and partial flap necrosis (10.5%). In the follow-up assessment, the mean EQ-5D visual analog scale score was 78.8 (SD: 16.0). A total of 61.4% of patients maintained regular shoe use, and 81.8% did not require orthopedic procedures. No patient required debulking. The mean difference in thigh circumference between limbs was 10.32 mm (P = 0.0106).

CONCLUSIONS

The free adipofascial ALT flap provides a reliable reconstructive alternative for different anatomically demanding areas, enhancing rehabilitation, avoiding secondary procedures, and achieving good functional outcomes with low donor-site morbidity 1 year postoperatively.