Role of Anterolateral Thigh Flaps in Distal Lower Extremity Reconstruction: Assessment of Functionality, Aesthetics, and Patient Satisfaction

Abstract Background Distal lower extremity reconstruction presents many challenges due to the suboptimal vascular supply, the weight-bearing necessity, movement, and multiple tissue types that can be easily damaged by trauma, from bones, tendons, ligaments, muscle, and soft tissue loss. The anterolateral thigh flap provides a reconstructive option for large defects with good coverage and minimal donor-site morbidity. Methods After a chart review of all anterolateral thigh flaps, the patients were contacted to take a survey regarding their satisfaction and functional ability and to meet for measurements of their feet after debulking procedures. Results A total of 13 patients were included in the study, with traumatic injuries comprising 84% of cases. There was a significant difference in sizes of the midfoot (mean: 10.27 vs. 9.53, p = 0.004) and the hindfoot (mean: 12.92 vs. 12.2, p = 0.023) when comparing the affected side to the unaffected side. The majority, 77%, of our patients underwent debulking procedures. Overall, 75% of traumatic injury patients had > 90% maximum functionality score. All posttraumatic reconstruction results were rated satisfied to very satisfied by the patients. All posttraumatic patients were able to walk after their procedures, although three patients did require custom-made shoes with inserts or braces. Conclusion The anterolateral thigh flap is a versatile reconstructive option that can be used in the distal lower extremity and is especially useful after a traumatic injury as it allows for functional recovery and high patient satisfaction after debulking.