A Large Scalp Defect Coverage With Pedicled Free Flap Using the Wrist as a Free Flap Carrier

Area of Science:

• Plastic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Free flap transfer for scalp defects is often hindered by the lack of suitable recipient vessels.
• Challenges include difficult neck dissection and the thrombogenic risk associated with vein grafts for pedicle elongation.

Observation:

• A 78-year-old patient with a completely occluded common carotid artery presented with a large scalp defect.
• A two-stage reconstruction utilized the wrist as a "free flap carrier" for a latissimus dorsi muscle flap.

Findings:

• The wrist provided a viable "carrier" for pedicle anastomosis, using the radial artery and associated veins for inflow and outflow.
• The procedure involved a two-stage transfer, split-thickness skin grafting, and subsequent flap division with vein graft repair.
• Successful coverage of the scalp defect was achieved with no complications noted by postoperative day 14.

Implications:

• This wrist-as-carrier technique offers a viable alternative for scalp defect reconstruction when local recipient vessels are inadequate.
• It potentially mitigates the risks associated with traditional neck dissection and vein grafting in challenging cases.
• This innovative approach expands reconstructive options for complex head and neck defects.