New anterolateral thigh perforator flap with a short pedicle for reconstruction of defects in the upper extremities.

Three cases of successful transfer of a new free anterolateral thigh (ALT) perforator flap for coverage of soft-tissue defects in the hand and upper arm are described. This new flap has a thin superficial fatty layer, no fascial component, and is vascularized with a perforator of the descending branch of the lateral circumflex femoral system. The free flap is nourished by anastomosing of the perforator or the proximal small segment of the descending branch. The advantages of this flap are no need for deep dissection, minimal time for flap elevation, minimal donor site morbidity, preservation of the main trunk of the lateral circumflex femoral system, possible thinning of the flap with primary defatting, possible application as a flow-through flap, and a concealed donor scar. This flap is suitable for coverage of defects in the fingers, hands, and arms.