Abstract： Objective To study the surgical outcomes of simultaneous limb salvage using flow-through anterolateral thigh flaps for severe extremity injuries involving soft tissues and major blood vessels. Methods From May 2003 to February 2012,21 cases of severe extremity injuries were treated in our department.They were 13 men and 8 women,aged from 14 to 53 years (average,37.3 years).There were 4 cases of upper limb injury,17 cases of lower limb injury,14 cases of vascular rupture and defect and 7 cases of massive vascular contusion and thrombosis.In all the injured limbs,severe soft tissue defects were associated with major arterial damages and more or less exposure of the bone,tendon,blood vessel and nerve.Their Mangled Extremity Severity Scores (MESS) ranged from 5 to 8 points (average,5.8 points).The one-stage flow-through flap graft was conducted following thorough debridement in 8 patients with poor or disappeared distal blood supply; of the 13 patients with partial blood supply,6 underwent one-stage flap graft directly and 7 had secondary flap graft according to the wound condition following debridement. Results The 21 patients were followed for 3 to 43 months (average,11.8 months).All the flaps survived and all the injured limbs were salvaged.The blood supply to the distal limb was fine in all cases without any vascular crisis.Necrosis at partial flap margins (3 cases),partial necrosis at the donor site (2 cases),superficial infection (3 cases) and osteomyelitis (one case) were handled until improvement. Conclusion The flow-through anterolateral thigh flap,which can repair soft tissue defects and major vascular injuries simultaneously,is one of the preferable methods in limb salvage for severely damaged extremities.