Successful salvage of upper extremity following severe crush injury associated with vascular compromise using a supra thin free anterolateral thigh flap

Mahesh Jangra; Ajay Kumar; Nipun Sharma; Heishnam S. Singh; Tarush Gupta; Jerry R. John

doi:10.18203/2349-2902.isj20241160

Authors

Mahesh Jangra Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Ajay Kumar Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Nipun Sharma Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Heishnam S. Singh Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Tarush Gupta Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Jerry R. John Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20241160

Keywords:

Upper extremity trauma, Vascular injury, Flow-through flap, Free flap, ALT flap

Abstract

Traumatic injuries of the upper limbs can often result in serious and challenging wounds involving multiple compartments such as skin, bone, tendons and neurovascular structures. These type of injuries of the upper extremity pose several challenges to the plastic surgeon. The main difficulty is to provide a stable, long lasting and aesthetically acceptable coverage that enables joints excursion so that patient can return to work at the earliest. Here, we present a case of 45 years old gentlemen who sustained severe crush injury associated with avulsed radial and ulnar artery of left upper limb following road traffic accident. At presentation, there was no pin prick in his hand and hand was pale. At first surgery, hand was revascularized using a vein graft in radial artery and skin grafting was done over the forearm defect as a temporary cover. After 12 hours, when the viability of hand was reassured, the defect was covered with free supra thin anterolateral thigh (ALT) flap. Patient’s hand and flap both survived and he was discharged in a satisfactory condition.

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