Sensory Recovery of Foot and Ankle Reconstruction with Neurotized ALT Flaps: A Systematic Review

Background: The anterolateral thigh flap (ALT) is a reliable soft tissue reconstruction option, especially for lower extremity defects. Recent advancements in flap innervation methods show promise in promoting sensory recovery, yet the current literature lacks a comprehensive summary of its outcomes. Methods: A systematic review of PubMed, Embase, Web of Science, and Scopus was performed by identifying all studies examining sensory recovery outcomes in lower extremity reconstruction using innervated ALT flaps. Results: = 1, 0.9%) nerves. The overall complication rate was 16.5%, of which 11 (5.3%) were major flap complications requiring a return to the operating room. Overall, three studies found evidence of improved sensory recovery when using neurotized ALT flaps. Conclusion: Lower extremity reconstruction with innervated ALT flaps predominantly involves the foot and ankle region (98.5%), as the improved sensory recovery may be helpful in reducing secondary injury risk, such as diabetic foot ulcers. No cases involving reconstruction of soft tissue defects above the knee were identified.