A Randomized Clinical Study Comparing Aesthetic, Functional and Sensory Outcomes of Distant Pedicled Flap Versus Free Flap Reconstruction of Upper Limb Defects

Abstract Upper limb tissue defects may result from trauma, infection, burns, or tumor resection. Small superficial defects are amenable to skin grafting, whereas larger full-thickness defects with a wide zone of injury require coverage with pedicled or free flaps. The goal of reconstruction in upper limb defects is not only to achieve coverage but also to restore motor and sensory function as well as aesthetics. In this randomized study, patients who underwent resurfacing of upper limb defects between July 2022 and June 2024 were divided into two groups: distant pedicled flap (Group 1) and free flap (Group 2). Aesthetic, sensory, and functional assessment were performed at 3 and 6 months postoperatively, and statistical significance was analyzed between the two groups. A total of 40 patients were enrolled, with 22 patients in the pedicled flap group and 18 in the free flap group. Aesthetic analysis using the Likert scale showed better results in the free flap group. Both subjective and objective functional assessment showed better results in the free flap group at 3 months, with comparable results in both groups at 6 months. Sensory assessment showed similar results in both groups. With free tissue transfer, better overall outcomes were observed, including improved aesthetic appearance, earlier functional recovery, earlier return to work and daily activities, and better quality of life. In the presence of a dedicated microsurgical team, better reconstructive goals can be accomplished in upper limb reconstruction.