One-stage Reconstruction with the Composite Anterolateral Thigh Flap for Skin and Extensor Tendon Defects of the Thumb by Snakebite

Abstract

Venomous snakebites can cause severe injury. The loss of tendon and skin of the hand is incredibly challenging for the surgeon. A single-staged reconstruction with the free composite anterolateral thigh flap is an acceptable option for a complex thumb injury. In this case, reconstruction for a 23-year-old patient with a complex cobra-induced thumb injury had failed to cover the defect with a skin graft. There was a limitation in choice, and the patient was treated with the free composite anterolateral thigh (ALT) flap and fascia lata flap in one stage to reconstruct both the extensor tendon and the soft tissue coverage. The flap was well-vascularized, and no complications were reported. A single-stage reconstruction with a composite ALT flap with vascularized fascia was chosen as a suitable alternative. The result is satisfying both aesthetically and functionally. This technique can help shorten treatment time and restore function quickly, allowing patients to return to work in less time. The disadvantages of this technique are flap thickness, which can affect finger movement and aesthetics. The composite ALT flap with vascularized fascia lata shows that it is a reliable procedure for single-staged reconstruction, especially combined with the tendon preparation in the hand.

Fig. 1.

After debridement of skin graft failure in the snakebite wound, EPL tendons, and dorsal overlying skin defects.

Fig. 2.

Composite-free ALT and FL flap with one perforator were harvested. Tendon defect reconstruction was done by FL flap, and soft tissue defect was covered by thinned ALT flap. “A” indicates the flap pedicle; B, the FL flap; C, the skin paddle.

Fig. 3.

Twenty months follow-up result. The patient can fully adduct the hand.

Fig. 4.

Twenty months follow-up result. There was some limitation of the IP joint of the thumb when flexed.