"Wing flaps": perforator-based pedicled paraumbilical flaps for skin defects in hand and forearm

Single large-area or 2 small- to moderate-sized raw areas in the hand and forearm are difficult to cover with conventional groin or superficial inferior epigastric artery (SIEA) flaps. Though abdomen is a favorable donor site for a pedicled distant flap for soft tissue coverage of the hand and forearm, pedicle flaps based on paraumbilical perforators are not commonly used.

We herein describe a method of soft tissue coverage using 2 flaps based on 1 paraumbilical perforator in certain difficult clinical situations, unsuitable to be covered with groin or SIEA flaps. By virtue of having a very narrow common pedicle for 2 substantially large flaps close to the chosen paraumbilical perforator, the configuration of it prompted us to call these twin flaps "wing flaps," or a winged version of paraumbilical pedicle flaps. The wing flap described was used to cover twin raw areas (in 6 cases) and a large area (in 1 case) in the hand and forearm.

All 7 flaps went on to heal very well and served the purpose. The only complication observed was a minor thumb web contracture in one case, which improved with physiotherapy.

The winged version of pedicled paraumbilical perforator flaps should find a place in the surgical armamentarium for soft tissue coverage in the hand and forearm in difficult situations. The advantages and simplicity of these flaps have been described, based on our experience in a small series of 7 cases.