Background: Random pattern flaps are widely used in reconstructive surgery when inadequate vascularity precludes skin graft survival or when regional pedicled flaps are unavailable due to local burn injury. Here, thin tissue from the upper arm was utilized to cover exposed cartilage over the proximal interphalangeal (PIP) joints of the contralateral hand. Methods/Technical Note: We report the uncommon application of multiple cross-arm (Colson) flaps to reconstruct dorsal skin defects over the PIP joints of the index, middle, and ring fingers following a high-voltage burn injury, in conjunction with a comprehensive literature review. Results: Three separate random-pattern flaps were harvested from the upper arm and transferred to the contralateral hand. All flaps demonstrated good perfusion, durable coverage, and a clean wound bed postoperatively, with preservation of joint mobility. Conclusions: To our knowledge, this represents one of the first reported reconstructions of multiple adjacent PIP joints using individual cross-arm flaps. This technique remains a dependable salvage option that should be considered in complex reconstructive scenarios when local or microsurgical options are not feasible.

Background and Objectives: Free tissue transfer for coverage of large defects is a common technique in plastic surgery. The kind of free tissue transfer depends on various factors such as the size of the defect, type and content of missing tissue, the location, and the weight-bearing demands of the area. Instead of performing bulky muscle free flaps, another alternative has bas been considered. Materials and Methods: This is a technical experience report for ALTP Flap Surgery conducted from 2013 to 2017 which included 15 surgery reviews out of 50 based on the inclusion criteria to identify the result of aesthetical reconstruction and to include such results with the current literature. In addition to that, a narrative review of the literature has been performed using PubMed and Google Scholar by using the ALT or ALTP Flap terms to determine the current practice and to compare with our results. Results: Single-stage debridement of all defects was followed by reconstruction in all surgeries. A total of 14 Flaps succeeded (93.3%) without any complications and only one of the flaps was complicated (6.7%) with vein thrombosis which resulted in the loss of that flap, leading to another revision being performed for that particular patient. No hematoma or infection has been noted. Conclusions: Using an extended-size ALTP flap can be a reliable option for the reconstruction of the weight-bearing area of the foot and offers a good postoperative function and esthetic result without the need of further subsequent debulking procedures.