USE OF PATTERNED PEDICLED PARAUMBILICAL PERFORATOR-BASED FLAPS FOR COVERAGE OF THE DEFECTS OF FOREARM AND HAND

Purpose: Hand and upper extremity traumatic soft tissue defects are frequent and can present difficulties for reconstructive surgeons. We present a novel technique to reconstruct forearm and hand defects using the patterned pedicled paraumbilical perforator-based flap. This flap is simple to harvest, has low donor site morbidity, and allows elbow and shoulder range of motion during the interval between flap transfer and pedicle division. This prospective clinical inte Methods: rventional study involved 10 patients who had soft tissue defects over the hand and upper extremity. These patients underwent reconstruction with a patterned pedicled paraumbilical perforator-based flap. The study analysed various factors including age, sex, aetiology, type and extent of the defect, defect dimensions, flap particulars, donor site morbidity, postoperative complications, necessity of additional revision procedures and follow-up. Results: There were 10 cases aged between 20 to 45 years. Trauma resulting from road traffic accidents was the most common cause of injury. Majority of defects were found in the dorsal aspect of hand. Defect dimensions varied from 8cm×5cm to 15cm×8 cm. The size of the flaps ranged from 9cm×7cm to 17cm×9 cm, and the pedicle length was 4 to 9 cm. A fairly large flap could be harvested and donor site could be closed primarily in majority of cases. Complications, including marginal flap necrosis and partial flap detachment, were observed in two cases. Conclusions: The flap is technically easy to plan and it drapes around upper limb defects, with no significant donor site morbidity and less postoperative limb oedema. Thus, this flap is very useful in coverage of the upper limb and recommended as a first-line flap for coverage of hand, forearm and elbow defects. Post-op upper limb physiotherapy is recommended to get optimal results.