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ALT Donor Area Compartment Syndrome: A Rare and Devastating Complication.

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Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
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Summary

Acute compartment syndrome (ACS) in anterolateral thigh (ALT) flap donor sites is rare but serious. Prompt detection and treatment are crucial to prevent muscle damage, with latissimus dorsi (LD) flaps offering functional restoration.

Keywords:
ALT flapcompartment syndromemicrosurgeryquadriceps reconstruction

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Area of Science:

  • Reconstructive surgery
  • Orthopedic surgery
  • Vascular surgery

Background:

  • Acute compartment syndrome (ACS) is a surgical emergency characterized by increased pressure within a fascial compartment, leading to compromised blood flow and tissue damage.
  • Anterolateral thigh (ALT) flaps are commonly used in reconstructive surgery, but complications in the donor area are infrequent.
  • The donor site of an ALT flap involves the anterior thigh, including the quadriceps muscle group.

Observation:

  • Two cases of ACS occurred in the donor area of ALT flaps, resulting in extensive quadriceps muscle necrosis.
  • Patients presented with severe pain, a hallmark symptom of ACS, though this may be masked by epidural analgesia.
  • An innervated latissimus dorsi (LD) flap was utilized to reconstruct the defect and restore lower extremity function.

Findings:

  • ACS in the ALT donor area is an exceptionally rare complication.
  • Potential contributing factors include multifactorial mechanisms, prevalence in young athletic males, and possible anatomical vascular variations.
  • Early detection is critical to prevent irreversible muscular ischemia and functional loss.

Implications:

  • The study highlights the importance of vigilant monitoring of ALT flap donor sites, particularly in high-risk patients or those receiving epidural analgesia.
  • Prompt recognition and management of ACS are essential to optimize outcomes and minimize morbidity.
  • Free functional LD muscle flaps represent a viable reconstructive option for severe quadriceps damage, enabling wound closure, soft-tissue coverage, and restoration of knee extension.