Compartment syndrome as a donor-site complication of anterolateral thigh free flap: a case report

Abstract

Compartment syndrome (CS) occurs infrequently as a complication at the donor site of an anterolateral thigh free flap (ALT-FF). We treated a 26-year-old male patient who was a professional soldier with large thigh muscles. A defect on the right ankle was reconstructed with a 30×10-cm2-sized ALT-FF. By the pinch test, the flap width was designed to be sufficient for primary closure of the donor site. However, on postoperative day 8, severe pain, tension, and purulent discharge were found at the donor site. We diagnosed CS clinically, and immediately performed incision and drainage. Various extrinsic and intrinsic factors can influence the development of CS. Therefore, in patients with these contributing factors, such as young men with high muscle mass, a higher level of suspicion for CS is needed. Moreover, it would be safer to design the flap width to be smaller than the pinch test would indicate or to cover the donor site with a skin graft.