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

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.