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[Clinical application of vasularisied anterolateral thigh fascial flap].

OBJECTIVE
To evaluate a modified anterolateral thigh fascial flap designed for the treatment of the soft tissue defects in the forearms and hands.


METHODS
From September 2000 to December 2003, a modified anterolateral thigh fascial flap combined with the intermediate split thickness skin graft was applied to the treatment of 13 patients with the soft tissue defects in the forearms or the hands. There were 8 males and 5 females, aged 19-43 years (average, 27. 6 years). Three patients had a mangled injury, 4 had a belt injury, and 6 had a crush injury; 6 patients had their tissue defects on the palm side of the forearm, 6 had their tissue defects on the dorsal side of the hand, and 1 had the defect in the index finger (dorsal side of the hand). The tissue defects ranged in size from 17. 5 cm x 7. 7 cm to 4. 6 cm x 3. 4 cm. In addition, 4 of the patients had an accompanying fracture in the forearm or the hand, and the remaining 9 had an extenor tendon injury. All the patients underwent emergency debridement and reposition with an internal fixation for the fracture; 3-5 days after the repair of the injured nerves, muscle tendons and blood vessels, the tissue defects were repaired with the anterolateral thigh fascial flap combined with the intermediate split thickness skin graft.


RESULTS
No vascular crisis developed after operation. All the flaps survived except one flap that developed a parial skin necrosis (2.0 cm x 1.0 cm) in the hand, but the skin survived after another skingrafting. The follow-up for 3-12 months revealed that all the flaps and skin grafts had a good appearance with no contracture of the skin. According to the evaluation criteria for the upper limbs recommended by the Hand Society of Chinese Medical Association, 9 patients had an excellent result, 2 had a good result, I had a fair result, and 1 had a poor result, with a good/excellence rate of 85%.


CONCLUSION
The modified anterolateral thigh fascial flap combined with the skin graft is one of the best methods for the treatment of the soft tissue defects in the forearms and the hands. This method has advantages of no requirement for a further flap reconstruction, no skin scar or contracture in the future, easy management for the donor site, and less wound formation.