Reconstruction of extensive upper extremity defects using pre-expanded oblique perforator-based paraumbilical flaps

Area of Science:

• Plastic Surgery
• Tissue Engineering

Background:

• The pedicled paraumbilical flap is a standard reconstructive option for hand and forearm defects.
• Limitations in flap size and pedicle dimensions restrict its use in extensive upper limb injuries.

Observation:

• This study evaluated the pre-expansion of pedicled paraumbilical flaps in 25 patients over 10-24 weeks.
• Flap sizes ranged significantly, from 10 cm × 8 cm to 30 cm × 14 cm, to cover large upper extremity defects.
• Donor sites were closed directly, and all flaps survived with minor partial necrosis in two cases.

Findings:

• Pre-expansion significantly increases the size and vascularity of paraumbilical flaps.
• This technique allows for the successful reconstruction of extensive upper limb defects previously untreatable with standard paraumbilical flaps.
• The procedure demonstrated reliability, with a high flap survival rate.

Implications:

• Pre-expanded paraumbilical flaps provide a viable, larger tissue transfer option for complex upper limb reconstructions.
• This method expands the reconstructive potential for patients with significant tissue loss in the upper extremity.
• Sufficient time for tissue expansion is crucial for successful outcomes in these challenging cases.