Optimizing upper extremity reconstruction: outcomes of anterolateral thigh (ALT) flap in complex hand injuries

Aim: The anterolateral thigh (ALT) flap has become a widely used option for soft tissue reconstruction in upper extremity injuries due to its versatility, reliability, and minimal donor site morbidity.This study evaluates the functional and aesthetic outcomes of ALT flap applications in complex hand trauma cases.Material and Methods: A retrospective analysis was conducted on 30 patients who underwent ALT flap reconstruction for upper extremity defects.Patients' demographics, injury mechanisms, surgical procedures, defect and flap dimensions, postoperative complications, and functional outcomes were assessed.Functional recovery was evaluated using MAYO and Q-DASH scores.Results: The mean defect size was 98.6752.34cm (min: 20, max: 260), and the average flap size was 134.1271.42cm (min: 36, max: 290).60% (n=18) of patients had radial artery anastomosis, while 23.3% (n=7) had ulnar artery end-to-end anastomosis.No total flap loss was observed, though 46.7% (n=14) of patients experienced minor complications, such as partial flap necrosis or donor site hematoma.Functional assessment revealed an average MAYO score of 71.8210.45and a Q-DASH score of 30.477.59,indicating satisfactory functional recovery.Discussion: The ALT flap provides excellent functional and aesthetic outcomes in upper extremity reconstruction.Compared to other flap options, it offers greater tissue volume, lower donor site morbidity, and enhanced cosmetic outcomes.Despite its technical complexity, it remains a gold standard in complex hand trauma management, with low complication rates and predictable functional recovery.