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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Abdominal Based Distant Flaps for Upper Extremity Defect Coverage
Brian Q. Le, MD; Yitzchok Greenberg, MD; Ajul Shah, MD; Jacques Henri Hacquebord, MD; Vishal D Thanik, MD; David Chiu, MD
New York University, New York, NY

HYPOTHESIS
The hand surgeon must be familiar with the various surgical techniques available for upper extremity soft tissue reconstruction. We hypothesize that the abdominal based distant flaps provide a reliable means of soft tissue coverage for defects involving the upper limb.

METHODS
We performed a retrospective review of 5 patients within the past 2 years at our institution who have received thoraco-epigastric or any superiorly or laterally oriented, abdominal based distant flap to cover upper extremity defects. Figure 1. We examine the mechanism, concomitant injuries, size and location of the defect as well as age and medical comorbidities of each patient. The time between the initial surgery and division and inset is noted, as are complications and need for revisions.

RESULTS
The demographics of each of the five patients is shown in Figure 2. We find that for each of the first four patients with relatively small size defects <30 cm2, there was no partial flap loss or additional complications. However patient #5 who suffered partial flap necrosis, required a third surgery for microvascular free tissue transfer to cover the distal defect which was the portion of the wound with exposed hardware.

SUMMARY

  • Potential vascular compromise in an already injured extremity makes the abdominal based distant flap a reliable option for soft tissue coverage over free tissue transfer
  • Ideal for patients who cannot tolerate long surgeries and prolonged exposure to anesthesia
  • The vascular pedicle to the abdominal based flaps is within Scarpa's fascia and therefore yields a thin pliable flap.
  • Ability to base the flap superiorly, inferiorly or laterally allows for optimal patient positioning without untoward tension on the flap.

    images/Paper_25794_abstract_16107_0.jpg


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