Arch Hand Microsurg.  2022 Mar;27(1):83-87. 10.12790/ahm.21.0095.

Compartment syndrome as a donor-site complication of anterolateral thigh free flap: a case report

• Moon BM
• Pae WS

• KMID: 2526654
• DOI: http://doi.org/10.12790/ahm.21.0095

Abstract

Compartment syndrome (CS) occurs infrequently as a complication at the donor site of an anterolateral thigh free flap (ALT-FF). We treated a 26-year-old male patient who was a professional soldier with large thigh muscles. A defect on the right ankle was reconstructed with a 30×10-cm2-sized ALT-FF. By the pinch test, the flap width was designed to be sufficient for primary closure of the donor site. However, on postoperative day 8, severe pain, tension, and purulent discharge were found at the donor site. We diagnosed CS clinically, and immediately performed incision and drainage. Various extrinsic and intrinsic factors can influence the development of CS. Therefore, in patients with these contributing factors, such as young men with high muscle mass, a higher level of suspicion for CS is needed. Moreover, it would be safer to design the flap width to be smaller than the pinch test would indicate or to cover the donor site with a skin graft.

Keyword

Anterolateral thigh free flap; Compartment syndromes; Doner-site complication

Figure

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  Fig. 1. (A, B) A 26-year-old male had a right distal tibia and lateral malleolus fracture (Gustilo IIIC), with rupture of Achilles tendon and vessel injury. (C) A 30×10 cm2 anterolateral thigh free flap harvested from the contralateral thigh. (D, E) The flap after inset.

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  Fig. 2. At the donor site, compartment syndrome was diagnosed clinically on postoperative day (POD) 8, and incision and drainage were performed immediately. (A) On POD 10, muscle necrosis and pus-like discharge were still present. After primary suture of the proximal area, secondary wound healing occurred in the remaining area. (B) Scars on POD 90.

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  Fig. 3. Computed tomography image of the preoperative donor site (left thigh), showing a large amount of muscle mass. The flap thickness was 6.9 mm.

Reference

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