{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:04:26Z","timestamp":1780095866206,"version":"3.54.0"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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\u20133 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\n. 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.<\/jats:p>","DOI":"10.1055\/a-2844-9708","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T22:48:11Z","timestamp":1780094891000},"page":"257-266","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1055","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6282-7466","authenticated-orcid":false,"given":"Hui Yuan","family":"Lam","sequence":"additional","affiliation":[{"name":"Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kota Bharu, Kelantan, Malaysia"},{"name":"Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0600-9765","authenticated-orcid":false,"given":"Wan Azman Wan","family":"Sulaiman","sequence":"additional","affiliation":[{"name":"Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kota Bharu, Kelantan, Malaysia"},{"name":"Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4003-6783","authenticated-orcid":false,"given":"Arman Zaharil Mat","family":"Saad","sequence":"additional","affiliation":[{"name":"Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kota Bharu, Kelantan, Malaysia"},{"name":"MSU Medical Centre, Management and Science University, No. 4 Persiaran Olahraga, Shah Alam, Selangor Darul Ehsan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8999-6403","authenticated-orcid":false,"given":"Ahmad Sukari","family":"Halim","sequence":"additional","affiliation":[{"name":"Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kota Bharu, Kelantan, Malaysia"},{"name":"Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/0007-1226(74)90054-X","article-title":"Hand injuries requiring skin replacement and restoration of tendon function","volume":"27","author":"D AC Reid","year":"1974","journal-title":"Br J Plast Surg"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.cps.2014.03.012","article-title":"Extensor tendon repair and reconstruction","volume":"41","author":"C D Schubert","year":"2014","journal-title":"Clin Plast Surg"},{"issue":"12","key":"ref3","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1016\/j.bjps.2008.06.016","article-title":"Use of composite anterolateral thigh flap as double-vascularised layers for reconstruction of complex hand dorsum defect","volume":"61","author":"S Yazar","year":"2008","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S0749-0712(02)00142-7","article-title":"Outcomes after mutilating hand injuries: review of the literature and recommendations for assessment","volume":"19","author":"R A Bueno Jr","year":"2003","journal-title":"Hand Clin"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/S0749-0712(21)00466-2","article-title":"The management of bone defects of the forearm after trauma","volume":"15","author":"M Stevanovic","year":"1999","journal-title":"Hand Clin"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.cuor.2004.12.003","article-title":"Extensor tendon injuries in the hand","volume":"18","author":"A C Watts","year":"2004","journal-title":"Curr Orthop"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/S0266-7681(97)80409-3","article-title":"Subcutaneous extensor tendon rupture associated with calcium pyrophosphate dihydrate crystal deposition disease of the wrist","volume":"22","author":"Y Taniguchi","year":"1997","journal-title":"J Hand Surg [Br]"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/S0072-968X(80)80018-0","article-title":"Closed rupture of extensor digitorum communis tendon following fracture of the radius","volume":"12","author":"I Mackay","year":"1980","journal-title":"Hand"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"e3858","DOI":"10.1097\/GOX.0000000000003858","article-title":"Two-stage reconstruction of hand extensor tendons using silicon rods","volume":"9","author":"M KB Abdulaziz","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/0266-7681(93)90005-Z","article-title":"Primary extensor tendon reconstruction in dorsal hand defects requiring free flaps","volume":"18","author":"L R Scheker","year":"1993","journal-title":"J Hand Surg [Br]"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/micr.10086","article-title":"Flap coverage of dorsum of hand associated with extensor tendons injuries: A completely vascularized single-stage reconstruction","volume":"23","author":"R Adani","year":"2003","journal-title":"Microsurgery"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/S0266-7681(96)80102-1","article-title":"A comparison of immediate and staged reconstruction of the dorsum of the hand","volume":"21","author":"M Sundine","year":"1996","journal-title":"J Hand Surg [Br]"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/S0007-1226(79)90030-4","article-title":"Composite free flap and tendon transfer: an anatomical study and a clinical technique","volume":"32","author":"G I Taylor","year":"1979","journal-title":"Br J Plast Surg"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0753-9053(87)80005-4","article-title":"Hand reconstruction following avulsion of all dorsal soft tissues. A cutaneo-tendinous free tissue transfer","volume":"6","author":"V R Hentz","year":"1987","journal-title":"Ann Chir Main"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/00006534-198509000-00015","article-title":"Transfer of vascularized extensor tendons from the foot to the hand with a dorsalis pedis flap","volume":"76","author":"R Vila-Rovira","year":"1985","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref16","first-page":"1326","article-title":"Dorsalis pedis flap with vascularized extensor tendons for dorsal hand reconstruction","volume":"92","author":"A Caroli","year":"1993","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/00000637-200209000-00013","article-title":"Free anterolateral thigh fasciocutaneous flap with a fat\/fascia extension for reconstruction of tendon gliding surface in severe bursitis of the dorsal hand","volume":"49","author":"G Muneuchi","year":"2002","journal-title":"Ann Plast Surg"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5455\/handmicrosurg.279646","article-title":"Single stage soft tissue and extensor tendon reconstruction of upper extremity with antero-lateral thigh free flap- a case report","volume":"7","author":"K Koh","year":"2017","journal-title":"Hand Microsurg"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"647","DOI":"10.2106\/00004623-196042040-00009","article-title":"Primary repair of flexor tendons","volume":"42","author":"C Verdan","year":"1960","journal-title":"J Bone Joint Surg Am"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/0363-5023(90)90024-L","article-title":"Long-term results of extensor tendon repair","volume":"15","author":"W F Blair","year":"1990","journal-title":"J Hand Surg Am"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.jpra.2023.11.011","article-title":"Using free chimeric anterolateral thigh flap for reconstruction of composite dorsal hand defect","volume":"39","author":"T T S\u01a1n","year":"2023","journal-title":"JPRAS Open"}],"container-title":["Archives of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2844-9708.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T22:48:35Z","timestamp":1780094915000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2844-9708"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":21,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2026,5,29]]},"published-print":{"date-parts":[[2026,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2844-9708","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2234-6163","2234-6171"],"issn-type":[{"value":"2234-6163","type":"print"},{"value":"2234-6171","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}