Long-Term Functional Outcomes of Posttraumatic Complex Extensor Tendon Reconstruction in Hand and Forearm Using Composite Anterolateral Thigh Free Flaps: A Case Series and Literature Review.

Complex dorsal hand and forearm injuries with extensor tendon and soft tissue loss are challenging to manage. Single-stage reconstruction using composite anterolateral thigh (ALT) fasciocutaneous free flaps with vascularized fascia lata may reduce the need for multiple surgeries and accelerate functional recovery, but clinical evidence is limited. We conducted a retrospective case series of nine patients with complex extensor tendon and soft tissue defects who underwent single-stage reconstruction with composite ALT flaps between 2009 and 2018. Six patients were available for long-term follow-up (average 2-3 years). Data included demographics, injury characteristics, operative details, complications, and functional outcomes assessed using Miller's criteria. One donor site hematoma resolved without sequelae. Functional assessment revealed that two patients achieved excellent and poor outcomes in wrist and finger extension, respectively, while one patient demonstrated good and fair results . Poor outcomes were associated with missed follow-up, prolonged immobilization, and concomitant skeletal injuries. All patients returned to work and reported satisfaction with their functional status. This approach offers durable soft tissue coverage, restores tendon continuity, and allows early rehabilitation with minimal donor site morbidity.