Functional and Aesthetic Outcomes of the Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects: A Systematic Review

BACKGROUND: Soft tissue coverage in the upper limb after trauma, burn injury, or tumour removal is a commonly addressed problem by the plastic surgeon. The anterolateral thigh flap (ALT) is recognized as a popular free flap option for covering various types of soft tissue defects due to its versatility. We aimed to assess the functional and aesthetic outcomes of the ALT flap for reconstruction of upper limb defects. METHODS: Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, and Cochrane) from inception to Feb 2021. Two reviewers independently extracted the data and performed risk assessment using the modified Downs and Black (MDB) quality assessment tool and the modified Newcastle Ottawa Scale for case series. RESULTS: This review included seven studies for quantitative assessment. The eligible studies had 67 patients. Included studies had used a varied number of validated upper extremity functional scoring systems; the most commonly used score was QuickDASH with mean of 21.24, DASH score was 15.5. In regard to aesthetic outcome, an overall satisfactory result was reported. A secondary debulking procedure was performed in 7 patients. CONCLUSION: Further studies are recommended to ascertain the functional and aesthetic outcomes of the ALT free flap for upper limb defects, especially using standardized outcome scoring systems. This may be supplemented with a questionnaire that addresses common patient concerns (such as colour, contour, textile and hair growth) for the aesthetic outcome. Nevertheless, based on our review, the ALT flap may be a good reliable reconstructive option for upper limb defects with good functional outcome and satisfactory aesthetic results.