Single-stage elbow reconstruction using thinned anterolateral thigh flaps: technical insights from perforator anatomy

Reconstruction of complex soft-tissue defects around the elbow requires both durable coverage and preservation of joint mobility. Although the anterolateral thigh (ALT) flap is a versatile option, its bulk often limits range of motion (ROM) and results in less aesthetic outcomes. This study presents a refined, single-stage thinning technique for ALT flaps, guided by perforator anatomy. The thinning strategy was determined by the perforator's characteristics. The orientation and number of perforators dictated the specific thinning method employed. Preservation of a fascial island surrounding the perforator maintained the flap's blood supply. The clinical utility of this technique is illustrated by two representative cases involving severe post-traumatic and post-burn elbow contractures. Single-stage thinned ALT flaps, customized using perforator-based algorithms, offer a reliable, pliable, and aesthetically favorable solution for elbow reconstruction. This method enables immediate functional gliding of the underlying structures and reduces the need for secondary procedures, thereby effectively restoring joint mobility.