title: The combined ALT-groin flap for the mutilated and degloved hand.
abstract: BACKGROUND
  Degloving and mutilation of the hand is a rare but formidable challenge. When replantation is not possible, we rely on distant pedicled flaps. We present a technique using pedicled anterolateral thigh (ALT) and groin flaps to sandwich and resurface the degloved hand. The purpose of this study is to describe the rationale, indications, methods and outcomes of combined pedicled ALT and groin flap reconstruction of the degloved hand.
  
  
  METHODS
  Five injuries were treated at this center between 2011 and 2014. Charts were retrospectively reviewed and outcomes evaluated. Four ALT-groin flaps were performed in a single stage for degloving, crush and combined injuries. In one case, partial necrosis of a tight groin flap necessitated secondary ALT coverage at a second stage.
  
  
  RESULTS
  Flaps survived after division at 4 weeks, and venous congestion was not observed at any point. Debulking, syndactyly release and toe transfer followed reconstruction to enhance outcomes.
  
  
  CONCLUSIONS
  The combined ALT-groin flap is safe and feasible for the reconstruction of the degloved or mutilated hand when replantation is not an option. It is attractive for familiar donor anatomy, donor-site morbidity and the quantity and composition of the tissue it provides.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Zelken
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
authors.forename: Nai-jen
authors.initials: NJ
authors.lastname: Chang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
authors.forename: Fu-chan
authors.initials: FC
authors.lastname: Wei
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan. Electronic address: lukechlin@gmail.com.
authors.forename: Cheng-hung
authors.initials: CH
authors.lastname: Lin
mesh_terms: D000328:Adult; D004954:Esthetics; D005260:Female; D006119:Groin; D006230:Hand Injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D013624:Taiwan / Q000453:epidemiology; D013709:Tendon Transfer / Q000379:methods*; D013848:Thigh; D014034:Toes / Q000294:innervation / Q000637:transplantation*; D016896:Treatment Outcome
keywords: Anterolateral thigh flap; Degloving; Hand reconstruction; Mutilated hand