Our study is aim to explore predictors for failure of anterolateral thigh (ALT) flap in the reconstruction of upper extremity. We performed a retrospective study for 509 patients who underwent ALT flap in the reconstruction of upper extremity. Among them, 27 patients suffered from necrosis of ALT flap (necrosis group, NG) and 482 gained survival of this flap (survival group, SG). We collected possible factors including 3 aspects: demographic variables - age, sex, body mass index (BMI), history of hypertension, diabetes, heart disease, smoking and alcohol, trauma mechanism, and postmenopausal; surgical-related variables - surgical duration, blood loss, number of reconstructed veins, flap size, perforator type, diameter of perforator, and vein graft; blooding variables - hemoglobin, D-dimer, white blood cell, red blood cell, and platelet count (PLT). We compared the above data between NG and SG by univariate, multivariate, and Kaplan-Meier method coupled with a log-rank test linear regression analysis. The survival incidence of ALT flap repairing upper extremity was 94.7% (482 of 509). The outcome of univariate analysis showed that age (53.5 +/- 9.2), BMI (26.7 +/- 4.5), larger flap size (24.3*9.2), D-dimer (0.58 +/- 0.10), and PLT (278.1 +/- 34.4) in NG were significantly higher than these (44.2 +/- 7.9, 22.3 +/- 4.2, 19.1*7.9, 0.48 +/- 0.08, 236.6 +/- 30.5) in SG. However, diameter of perforator (1.07 +/- 0.02) in NG was markedly smaller than that (1.12 +/- 0.02) in SG. Additionally, female patients, postmenopausal, patients with using venous stapler or 1 reconstructed vein had a higher failure rate. Multivariate and Kaplan-Meier method implied the same results. In summary, many factors were related with failure of ALT in the reconstruction of upper extremity. Postmenopausal, D-dimer, and PLT were the first considered as risk factors for ALT flap repairing upper extremity.