Objective To explore the clinical effect of using free anterolateral thigh flaps （ALTF） to repair severe diabetic

foot ulcer wounds. Methods From January 2019 to September 2023，15 patients with severe diabetic foot ulcers were treated with free ALTF transplantation. The wound area ranged from 4.0 cm×6.0 cm to 8.0 cm×18.5 cm. Postoperatively， the patients received routine anti-infection， anticoagulation， anti-vascular spasm， and blood sugar control treatments. Follow-up was conducted for 6-24 months. The follow-up contents included flap appearance， sensation， wound healing， ulcer recurrence， foot function， and the condition of the donor area. Results Among the 15 cases，13 cases had complete flap survival，1 case had partial flap survival， and 1 case experienced necrosis within 72 hours after surgery. The case with partial flap survival healed after active wound dressing changes and symptomatic treatment. In the 14 cases with flap survival， the foot flaps had an aesthetically pleasing appearance， two-point discrimination ranged from 8 to 15 mm， and there was no recurrence of ulcers. The donor site in all patients healed linearly without affecting the range of motion of the hip and knee joints. According to the Maryland Foot Function Score， the foot function scores were as follows：5 cases rated excellent，7 cases rated good， and 2 cases rated fair. Conclusion The use of free anterolateral thigh flaps can effectively repair severe diabetic foot ulcers. However， strict control of surgical indications and active management and control of complications are necessary， otherwise， there is a certain risk of poor healing or even necrosis of the flap

Diabetic foot, Ulcer, Anterolateral thigh flap, Microsurgery