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Updated: Aug 16, 2026
Vascularized Composite Upper Limb Allograft Harvesting for Proximal Arm Allotransplantation
Published on: June 13, 2025
Use of the anterolateral thigh free flap for upper-extremity reconstruction
Howard T Wang1, James W Fletcher, Detlev Erdmann
1Division of Orthopedics and Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Purpose:
The anterolateral thigh free flap (ALTF) first was reported in 1984 and has been used in large series with success for a multitude of clinical purposes. We describe our results with the ALTF in upper-extremity and hand reconstruction.
Methods:
From 1996 to 2003 there were 15 patients who had reconstruction of the hand and upper extremity using the ALTF. The parameters used to assess the outcome of our series included the success rate of the flap as measured by flap survival rate and adequacy of skin coverage, ability to close the donor site primarily or necessity of a skin graft, complications associated with the flap, donor site, and non-flap-related complications such as pulmonary embolism.
Results:
Of the 15 patients with an ALTF, 3 (20%) had a musculocutaneous perforator and 12 (80%) had a septocutaneous perforator. Two patients had a neurotized ALTF reconstruction. There were 4 complications related to the flap with 1 complete flap failure. The overall flap survival rate was 93%. The donor site was closed primarily in 8 patients (53%) and with a skin graft in 7 patients (47%). One donor site breakdown occurred.
Conclusions:
Our results show many advantages of the ALTF for upper-extremity reconstruction. Because of its versatility the ALTF is suited ideally for upper-extremity reconstruction and should be considered as part of the reconstructive ladder.
