Reconstruction of Snakebite-induced Hand Defects Using Free Anterolateral Thigh Adipofascial Flap with Skin Grafting: A Literature Review.

BACKGROUND

Treating complex hand defects from cobra bites is a significant challenge for plastic surgeons. Microsurgical fascia flaps, especially the free anterolateral thigh (ALT) fascial flap, have been successfully used to reconstruct exposed tendons and soft-tissue injuries in single-stage procedures.

METHODS

This study discusses the use of the free ALT adipofascial (AF) flap for the successful reconstruction of venomous cobra bite injuries. After debridement, the resulting wounds were complex, often presenting full-thickness soft-tissue defects with exposed tendons. We covered these with the flap and immediately applied full-thickness skin grafts.

RESULTS

Thirty free ALT-AF flaps were used, with an average flap length of 11 cm and width of 5.6 cm, covering an area of 65.8 cm2, with a thickness of 2-3 mm. Donor sites were primarily closed, and the overall flap success rate was 97.7%. Hand function recovered to approximately two-thirds of the normal range of motion. There was 1 total flap failure and 2 partial skin graft losses. No secondary flap defatting or donor-site complications occurred.

CONCLUSIONS

The free ALT-AF flap with a skin graft is effective for reconstructing complex hand injuries and may improve aesthetic and functional outcomes in snakebite cases.