Pre-expanded Paraumbilical Perforator Flap

Reconstruction of Circumferential Upper Extremity Defect Using a Bipedicle Expanded Flank Flap

BACKGROUND

Resurfacing of extensive upper extremity lesions remains a challenge for plastic surgeons because of optimal functional and aesthetic outcomes and limitations of flap size. We introduced a pre-expanded flank flap to reconstruct the circumferential upper extremity defect in one sequence of tissue expansion.

METHOD

Between March 2015 and June 2019, 14 consecutive patients underwent reconstructive treatment for circumferential soft tissue lesions in the upper extremity using a bipedicle expanded flank flap. Surgical treatment was divided into 3 stages consisting of expander implantation in the flank area, bipedicle flap transfer to resurface the skin lesion on upper extremity, and flap pedicle transection. Flap survival, complications, and functional and aesthetic outcomes were evaluated.

RESULT

Fourteen patients with circumferential upper extremity lesions were enrolled in this study, 2 of them were diagnosed as extensive scar and 12 of them as giant congenital melanocytic nevi. Twelve patients completed more than 6-month follow-up. One or 2 tissue expanders were implanted in flank, lateral thorax, or abdomen area. The average time of tissue expansion was 25.9 weeks. The pedicled thoracoabdominal flaps were used to resurface a mean skin defect area of 406.6 cm2 ranging from 252 to 660 cm2. In all cases, primary donor site closure was achieved. Seroma developed in 1 case after flap transferred. With aspiration, the flap survived completely. No marginal necrosis was seen. The reconstructed limbs showed satisfactory outcome in both aesthetic and functional aspects.

CONCLUSIONS

The bipedicle expanded flank flap enables reconstruction of circumferential upper limb skin lesions in 1 sequence of tissue expansion with low complication rate and high patient satisfaction.

Contralateral lumbo-umbilical flap: A versatile technique for volar finger coverage

Background:

While contemplating any difficult soft tissue reconstruction, patient comfort and compliance is of paramount importance. Reconstruction of the volar aspect of fingers and hand by the ipsilateral pedicled flaps (groin flap, abdominal flaps) is demanding as the flap inset is difficult for the surgeon and very uncomfortable for the patient. This often leads to flap complications. For the comfort of the patient, better compliance and ease of complete inset, we planned to manage soft tissue defects of the volar aspect of fingers and hand by a new contralateral pedicled lumbo-umbilical flap. This flap is based on the paraumbilical perforators of deep inferior epigastric artery.

Materials and Methods:

The contralateral pedicled lumbo-umbilical flap was used in eight patients with high-tension electrical burn injuries involving the volar aspect of fingers and hand. The patients were closely observed for first 6 weeks for any flap or donor site complications and then followed monthly to assess donor and recipient site characteristics for 6 months to 2 years.

Results and Conclusion:

Large flaps up to 8 cm × 16 cm were raised. All but one flaps survived completely. All patients were mobilised within 48 h and five were discharged in less than a week after initial inset. The flap is reliable, easy to harvest and easy to inset on the volar aspect of fingers. The arm is positioned in a very comfortable position. The main disadvantage, however, is a conspicuous abdominal scar.