Tuesday, November 5, 2002
478

A Clinical Experience in the Coverage of Extensive Defects of the Upper Extremity

Moustapha Hamdi, MD, Koenraad Van Landuyt, MD, Phillip Blondeel, MD, and Stan Monstrey, MD.

Introduction: Classical skin free flaps are rarely used to cover large skin defects of the upper extremity because of the limited donor size. In our center, we have a wide experience with skin flaps. Using a muscle flap is limited to very specific indications and the amount of muscle required is restricted to the minimum in order to decrease the donor site morbidity. Material and Methods: We present a series of 10 patients who were admitted into our department with extensive defects of the upper extremity between December 1999 and December 2001. The mean defect was 30 x 14 cm. Thin flap such as thoracodorsal artery perforator TAP or lateral arm flap LAF was used for forearm and hand defects. Deep inferior epigastric perforator DIEP flap was indicated for deeper defects. Results: Free skin flaps (1 LAF, 2 TAP flaps, 4 DIEP flaps) were used in 6 patients. Chimera flap, which is a combination of two separated tissues based on one pedicle, was needed in 4 patients (scapular with TAP flap in one case and TAP with partial latissimus dorsi muscle in 3 cases). Immediate defatting of the DIEP flap on the wrist was performed to achieve immediate thin coverage. Average operative time was 4 hours 20 minutes (3 – 7 h). All but one of the flaps survived completely. There was one chimera flap where the cutaneous part of the flap was necrosed due to a postoperative hematoma. An adequate coverage and a complete wound healing were obtained. Conclusion: Skin flaps or perforator flaps can successfully be used to cover a large defect in an extremity with minimal donor site morbidity. Chimera flaps provide a large amount of tissue, a wide range of mobility and easy shaping, modeling and defatting.
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