One-stage Flexor Reconstruction With Anterolateral Thigh and Fascia Lata Rolls After High-Voltage Trauma: A Case Report.

Background: Electrical injuries from high-voltage power lines are unique forms of trauma that can create challenging wounds for reconstructive surgeons. Our patients, a man in his late thirties (Patient 1) and a man in his early twenties (Patient 2), both sustained upper extremity injuries after contact with a high-voltage line.

Methods: Despite minimal superficial damage, both patients required fasciotomies and debridement of the volar forearm, revealing segmental defects in most digital tendons as well as the distal median nerve. Free fasciocutaneous anterolateral thigh (ALT) flaps were harvested to ensure adequate wound coverage. Additionally, fascia lata grafts were taken from the free flap donor site and rolled into tubes to transfer available flexor digitorum superficialis proximal tendon stumps to the distal stumps of flexor digitorum profundus. The rolls were also used to bridge segmental tendon defects in flexor pollicis longus, while cadaveric nerve allografts were used to bridge the median nerve defects.

Results: Nine months postoperatively, Patient 1 had premorbid function with activities of daily living (ADLs), and Patient 2 required only minimal assistance with instrumental ADLs. Within a year following reconstruction, Patient 1 mostly regained range of motion in his digits with some rigidity, and Patient 2 regained full range of motion in his digits with minimal rigidity.

Conclusions: These cases have demonstrated that the use of an ALT free flap combined with rolled fascia lata graft tubes may be an effective choice for reconstruction and functional restoration in cases of severe high-voltage electrical trauma.