Double-paddle anterolateral thigh perforator flap for extensive soft-tissue reconstruction of the injured hands and feet.

This study investigates the outcomes of double-paddle anterolateral thigh (ALT) perforator flaps in repairing hand and foot wounds, with emphasis on intraoperative vascular variations. Between April 2019 and April 2021, 10 cases with large defects were planned to be treated using double-paddle ALT flaps based on two descending branches of the lateral circumflex femoral artery (DB-LCFA). In three cases, one perforator arose from an atypical source, and in one case, both skin paddles traced back to a single perforator bifurcating near the skin. All flaps survived, except for one partial necrosis and one intraoperative perforator injury. Most donor sites were closed primarily; two required additional coverage. Follow-up (3-15 months) showed good functional and aesthetic recovery. These results support the double-paddle ALT flap as a viable reconstructive option. However, anatomical variations demand intraoperative adaptability, and when long pedicles are required, converting to two independent flaps may offer better reliability.