Skip to main content
Top
Published in: European Journal of Plastic Surgery 4/2022

19-01-2022 | Skin Graft | Original Paper

Ultra-thin abdominal flap for resurfacing of upper limb defects, an old technique, is it still valid?

Authors: Mohamed Elsayed Mohamed Mohamed, Mohamed Osama Adly Kotb

Published in: European Journal of Plastic Surgery | Issue 4/2022

Login to get access

Abstract

Background

The reconstruction of soft tissue defects of the hand, wrist, and forearm with exposed tendons, joints, bones, and neurovascular bundles represents a great challenge for plastic surgeons. Such defects require early and effective quality coverage to protect the underlying vital structures, preserve hand functions, and allow for early rehabilitation. This study aimed to evaluate the versatility of ultra-thin abdominal flap for the coverage of hand and forearm soft tissue loss with no or minimal morbidity or further debulking procedures.

Methods

From January 2013 to April 2019, all patients in whom ultra-thin abdominal flaps were used to resurface soft tissue defects of the hand and forearm were retrospectively reviewed and included in this study.  Patient satisfaction was also investigated and categorized into three groups: satisfaction with reconstructed defects, flap donor sites, and the graft donor site.

Results

Thirty flaps were used to resurface 30 upper limb defects with minimal complications and good esthetic outcome with no need for further flap debulking. Twenty patients were very satisfied with the defect coverage, nine were satisfied, and one patient was not satisfied. Regarding the flap donor site, 11 patients were very satisfied, 17 were satisfied, while two patients were not satisfied.

Conclusions

Soft tissue defects of the upper limb can be reconstructed effectively with the ultra-thin abdominal flap resulting in minor or no complications. This flap gives good results with minimal donor site morbidity if it is well designed and meticulously dissected.
Level of evidence: Level IV, Therapeutic study
Literature
1.
go back to reference Khan MM, Yaseen M, Bariar LM, Khan SM (2009) Clinical study of dorsal ulnar artery flap in hand reconstruction. Indian J Plast Surg. 42(1):52–57CrossRef Khan MM, Yaseen M, Bariar LM, Khan SM (2009) Clinical study of dorsal ulnar artery flap in hand reconstruction. Indian J Plast Surg. 42(1):52–57CrossRef
2.
go back to reference Kaufman MR, Jones NF (2005) The reverse radial forearm flap for soft tissue reconstruction of the wrist and hand. Tech Hand Up Extrem Surg 9(1):47–51CrossRef Kaufman MR, Jones NF (2005) The reverse radial forearm flap for soft tissue reconstruction of the wrist and hand. Tech Hand Up Extrem Surg 9(1):47–51CrossRef
3.
go back to reference Bocchi A, Quarta L, Di Castri A, Boschi E, Edoardo Caleffi Reverse perforator flaps in the reconstruction of the hand. Our Clinical Experience. The Open Orthopaedics Journal ISSN: 1874–3250 – Volume 11, 2017 Bocchi A, Quarta L, Di Castri A, Boschi E, Edoardo Caleffi Reverse perforator flaps in the reconstruction of the hand. Our Clinical Experience. The Open Orthopaedics Journal ISSN: 1874–3250 – Volume 11, 2017
4.
go back to reference Krishnamoorthy R, Karthikeyan G (2011) Degloving injuries of the hand. Indian J Plast Surg 44(2):227–236CrossRef Krishnamoorthy R, Karthikeyan G (2011) Degloving injuries of the hand. Indian J Plast Surg 44(2):227–236CrossRef
5.
go back to reference Matsui J, Piper S, Boyer MI (2014) Non-microsurgical options for soft tissue reconstruction of the hand. Curr Rev Musculoskelet Med 7(1):68–75CrossRef Matsui J, Piper S, Boyer MI (2014) Non-microsurgical options for soft tissue reconstruction of the hand. Curr Rev Musculoskelet Med 7(1):68–75CrossRef
6.
go back to reference Chen HC, Tang YB, Mardini S, Tsai BW (2004) Reconstruction of the hand and upper limb with free flaps based on musculo-cutaneous perforators. Microsurgery 24:270CrossRef Chen HC, Tang YB, Mardini S, Tsai BW (2004) Reconstruction of the hand and upper limb with free flaps based on musculo-cutaneous perforators. Microsurgery 24:270CrossRef
7.
go back to reference Sabapathya SR, Venkatramania H, Playab PM (2015) The use of pedicled abdominal flaps for coverage of acute bilateral circumferential degloving injuries of the hand. Trauma Case Rep 1(3–4):25–31CrossRef Sabapathya SR, Venkatramania H, Playab PM (2015) The use of pedicled abdominal flaps for coverage of acute bilateral circumferential degloving injuries of the hand. Trauma Case Rep 1(3–4):25–31CrossRef
8.
go back to reference Barillo DJ, Arabitg R, Cancio LC, Goodwin CW (2001) Distant pedicle flaps for soft tissue coverage of severely burned hands: an old idea revisited. Burns 27:613CrossRef Barillo DJ, Arabitg R, Cancio LC, Goodwin CW (2001) Distant pedicle flaps for soft tissue coverage of severely burned hands: an old idea revisited. Burns 27:613CrossRef
9.
go back to reference Gutwein LG, Merrel GA, Knox KR (2015) Paraumbilical perforator flap for soft tissue reconstruction of the forearm. J Hand Surg Am 40(3):586e592CrossRef Gutwein LG, Merrel GA, Knox KR (2015) Paraumbilical perforator flap for soft tissue reconstruction of the forearm. J Hand Surg Am 40(3):586e592CrossRef
10.
go back to reference O’Shaughnessy KD, Rawlani V, Hijjawi JB, Dumanian GA (2010) Oblique pedicled para-umbilical perforator-based flap for reconstruction of complex proximal and mid-forearm defects: a report of two cases. J Hand Surg Am 35(7):1105e1110 O’Shaughnessy KD, Rawlani V, Hijjawi JB, Dumanian GA (2010) Oblique pedicled para-umbilical perforator-based flap for reconstruction of complex proximal and mid-forearm defects: a report of two cases. J Hand Surg Am 35(7):1105e1110
11.
go back to reference Forli A, Voulliaume D, Comparin JP, Papalia I, Foyatier JL (2005) The abdominal flap-graft for coverage of soft tissue defects of the dorsum of hand and fingers in burn patients. Six cases reports. Ann Chir Plast Esthet 50:146–53CrossRef Forli A, Voulliaume D, Comparin JP, Papalia I, Foyatier JL (2005) The abdominal flap-graft for coverage of soft tissue defects of the dorsum of hand and fingers in burn patients. Six cases reports. Ann Chir Plast Esthet 50:146–53CrossRef
12.
go back to reference Buchlar U, Frey H (1991) Retrograde posterior interosseous flap. J Hand Surg Am 16:283CrossRef Buchlar U, Frey H (1991) Retrograde posterior interosseous flap. J Hand Surg Am 16:283CrossRef
13.
go back to reference Flügel A, Kehrer A, Heitmann C, Germann G (2005) Sauerbier M Coverage of soft-tissue defects of the hand with free fascial flaps. Microsurgery 25:47CrossRef Flügel A, Kehrer A, Heitmann C, Germann G (2005) Sauerbier M Coverage of soft-tissue defects of the hand with free fascial flaps. Microsurgery 25:47CrossRef
14.
go back to reference Hester TR, Nahai F, Beegle PE et al (1984) Blood supply of the abdomen revisited, with emphasis on the superficial epigastric artery. Plast Recontr Surg 74:657CrossRef Hester TR, Nahai F, Beegle PE et al (1984) Blood supply of the abdomen revisited, with emphasis on the superficial epigastric artery. Plast Recontr Surg 74:657CrossRef
15.
go back to reference El-Mrakby HH, Milner RH (2002) The suprafascial course of the direct paraumbilical perforators vessels. Plast Reconstr Surg 109:1766–1768CrossRef El-Mrakby HH, Milner RH (2002) The suprafascial course of the direct paraumbilical perforators vessels. Plast Reconstr Surg 109:1766–1768CrossRef
16.
go back to reference Lin W, Zheng T and Wang Q (2005) Study on the effect of pedicle skin flap of subdermal vascular plexus on repairing the hand injury. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 19(7):528 Lin W, Zheng T and Wang Q (2005) Study on the effect of pedicle skin flap of subdermal vascular plexus on repairing the hand injury. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 19(7):528
18.
go back to reference Monreal R, Gomez D, Osinaga G, de la Cruz PI and Monreal E (2017) Reconstruction of the hand defects by pedicled abdominal thin skin flaps. JOJ Orthoped Ortho Surg 1(1): JOJOOS.MS.ID.555555 Monreal R, Gomez D, Osinaga G, de la Cruz PI and Monreal E (2017) Reconstruction of the hand defects by pedicled abdominal thin skin flaps. JOJ Orthoped Ortho Surg 1(1): JOJOOS.MS.ID.555555
Metadata
Title
Ultra-thin abdominal flap for resurfacing of upper limb defects, an old technique, is it still valid?
Authors
Mohamed Elsayed Mohamed Mohamed
Mohamed Osama Adly Kotb
Publication date
19-01-2022
Publisher
Springer Berlin Heidelberg
Keyword
Skin Graft
Published in
European Journal of Plastic Surgery / Issue 4/2022
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-021-01919-w

Other articles of this Issue 4/2022

European Journal of Plastic Surgery 4/2022 Go to the issue

Short Communication

“Inverted” Froment sign