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Customized Reconstruction of Complex Soft Tissue Defects in the Upper Extremities with Variants of Double Skin Paddle Anterolateral Thigh Perforator Flaps
Jiqiang He, M.D and Juyu Tang, MD, Xiangya Hospital, Changsha, China

Background: Complex soft tissue defects in the upper extremities are challenging to reconstruct. The purpose of this study was sharing our experience in using the variants of double skin paddle anterolateral thigh perforator (ALT) flaps to achieve the customized reconstruction of the complex defects with good surgical outcomes and limited donor site morbidities..
Patients and methods: From January 2007 to December 2019, 15 patients (14 man and one woman) aged 15-61 years underwent double skin paddle ALT flaps reconstructions in the upper extremities. One wound is located in the elbow, four in the forearm, and 10 in the wrist or hand. All the wounds were large and non-adjacent defects with/without dead spaces. Four variants of double skin paddle anterolateral thigh perforator flaps were harvested according to the patient's needs.
Results: Fifteen patients were included in this series, these flaps included seven cases of classic double skin paddle ALT flaps, four cases of vastus lateralis muscle-chimeric double skin paddle ALT flaps, 2 cases of microdissected thin double skin paddle ALT flaps, and 2 cases of flow-through double skin paddle ALT flaps. One patient occurred flap necrosis because of pedicle kinking, all the other flaps survived without complications. The sizes of the skin flaps ranged from 6 × 6 cm2 to 26 × 7 cm2, and the sizes of the muscle segments ranged from 5 × 2 × 1 cm3 to 16× 6 × 2 cm3. The follow-up ranged from 7 to 54 months, with a median of 15.6 months. Donor thigh morbidity was minimal. Most of the patients were satisfied with the cosmetic appearance. The mean value of the qDASH scores at the last follow-up was 27.12 ± 16.51 (range 11.4-59.1). None of the patients showed wrist flexion deformity. Three patients developed finger joint stiffness postoperatively because of severe injury.
Conclusions: Variants of double skin paddle ALT flaps provide versatile designs and allow customized reconstruction of complex soft tissue defects in the upper extremities with limited donor site morbidities.


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