The use of the alt perforator flap for reconstruction of severe pediatric burn scar contractures

Pediatric burn injuries are frequently complicated by burn scar contractures that often create functional limitations. Usually release followed by skin grafts, local flaps or tissue expansion is adequate. In rare instances, when the contracture is severe and simpler forms of reconstruction have failed, microsurgical free tissue transfer becomes essential. Even though in pediatric patients it can be technically more demanding and there is a reported risk of vasospasm, free tissue transfer has proven to be a good alternative. It is a one-stage procedure that guarantees decent functional outcomes. The perforator anterolateral thigh flap is a workhorse flap in microsurgery. The versatility of this flap allows it to be used in various anatomic locations. In this paper we report its use in neck, wrist, foot and face reconstructions. Flap success rates were 100%, with no cases of partial or complete flap loss. No acute or chronic complications were noted. Only one patient required reoperation for thinning of the flap to allow proper shoe fitting. All patients had good functional outcomes and the contractures were fully released. Joint function was regained in all patients except one that required wrist fusion. When indicated, the free perforator ALT flap is an excellent option for challenging reconstructions.