Optimizing functional upper extremity reconstruction—Simultaneous free anterolateral thigh flap and tendon transfers—A case report

Composite upper extremity defects involving muscle–tendon units are amongst the most formidable reconstructive challenges and mandate functional restoration in addition to stable soft‐tissue coverage. Here, the authors present a case of a composite defect involving the extensor muscle–tendon units of the forearm resulting from surgical resection of a recurrent Merkel cell cancer. Functional restoration was achieved via multiple tendon transfers followed by soft tissue coverage with a free anterolateral thigh (ALT) flap. No donor‐ or recipient‐site complications were encountered and complete flap survival was noted. Following a 6‐week period of immobilization, physical therapy and range of motion exercises were initiated. Excellent functional outcome and high patient satisfaction were noted at 8 weeks postoperatively. In summary, simultaneous tendon transfers and microsurgical tissue transfer may provide a potentially superior approach for upper extremity reconstruction in complex composite defects. © 2014 Wiley Periodicals, Inc. Microsurgery 37:71–74, 2017.