Published: 2022-06-27

Micro-vascular reconstruction of complex post traumatic ankle and foot defects with free anterolateral thigh flap: single centre experience

Rakesh Kumar Jain, Prabhu Dayal Sinwar, Milan Pumbhadiya, Rahul Sharma


Background: Ankle and foot reconstruction is challenging for plastic surgeon due to paucity of local soft tissue and poor blood supply. Anterolateral thigh (ALT) free flap become popular reconstructive option where microsurgical expertise available.

Methods: Retrospective study of 26 patients of complex post traumatic ankle and foot defect underwent free anterolateral thigh free flap reconstruction during 2 years duration.

Results: ALT free flap provides satisfactory reconstructive option with only 8% flap loss in our study and minimal donor site morbidity. Flap thinning required in 19% patients on long term for adequate shoe fitting.

Conclusions: ALT free flap provide like with like tissue replacement for foot and ankle reconstruction with supple skin cover for subsequent surgeries if required.


Post traumatic, Ankle and foot defect, Microvascular reconstruction, Anterolateral thigh flap

Full Text:



Hollenbeck ST, Woo S, Komatsu I, Erdmann D, Zenn MR, Levin LS. Longitudinal outcomes and application of the subunit principle to foot and ankle free tissue transfers. Plast Reconstr Surg. 2010;125: 924-34.

Baux G, Fischer E, McCarthy J. Frank Hastings Hamilton: A pioneer American plastic surgeon. Plast Reconstr Surg. 2004;114:1240-7.

Heitmann C, Levin LS. The orthoplastic approach for management of the severely traumatized foot and ankle. J Trauma. 2003;54:379-90

Stark W. The use of pedicled muscle flaps in the surgical treatment of chronic osteomyelitis resulting from compound fractures. J Bone Joint Surg. 1946;28: 343-50.

Li X, Cui J, Maharjan S, Lu L, Gong X. Reconstruction of the foot and ankle using pedicled or free flaps: perioperative flaps survival analysis. PLOS ONE. 2016;11(12):e0167827.

O’Brien BM, Macleod AM, Hayhurst JW, Morrison WA. Successful transfer of a large island flap from the groin to the foot by microvascular anastomoses. Plast Reconstr Surg. 1973;52:271-8.

Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984;37(2):149-59.

Heller L, Levin LS. Lower extremity microsurgical reconstruction. Plast Reconstr Surg. 2001;108:1029-41.

Fischer M, Gustilo RB, Varecka TF. The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft tissue injury. J Bone Joint Surg. 1991;73:1316-22.

Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg. 2009;92:421-30.

Saint-Cyr M, Schaverien M, Wong C, Nagarkar P, Arbique G. The extended anterolateral thigh flap: Anatomical basis and clinical experience. Plast Reconstr Surg. 2009;123:1245-55.

Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg. 2004;114:910-6.

Santanelli F, Tenna S, Pace A, Scuderi N. Free flap reconstruction of the sole of the foot with or without sensory nerve coaptation. Plast Reconstr Surg. 2002; 109(7):2314-22.