The modified bipedicled flap for reconstruction of oncological skin defects of the trunk and extremities

Oncological skin defects of the extremities and trunk can be challenging. Our modified bipedicled flap utilises the principle of the bipedicled advancement flap, but allows for direct closure of the donor site (as opposed to skin grafting). It does not rely on the preservation of perforators and it random pattern, making it extremely versatile. We aimed to assess the outcomes for patients reconstructed using the modified bipedicled flap technique including oncological safety and complications.

Consecutive patients were retrospectively identified from July 2011 to January 2019 using operative records. Demographics, operative details, oncological data and complications were recorded from patient records and the institution's internal electronic patient records system. No cases, having a modified bipedicled flap, were excluded from this study.

One hundred flaps in 98 patients were included. Mean defect dimensions were 61.7 mm by 33.1 mm. Median length of stay was 1 day, time to discharge from dressing clinic was 15 days, and the length of follow-up was 6.0 years. Eight patients required oral antibiotics for suspected localised wound infection, and 6 patients had minor wound healing problems. There were no cases of flap failure, partial flap loss, returns to theatre for flap-related complications, or local disease recurrence.

To our knowledge, this is the largest series of bipedicled flaps published to date. Our technique is easy to execute, versatile, and allows for direct closure of the secondary defect with excellent cosmetic results. It is oncologically safe, with a low incidence of complications. We commend it for use in the reconstruction of oncological skin defects of the trunk and extremities.