Current indications for abdominal-based flaps in hand and forearm reconstruction

Area of Science:

• Reconstructive surgery
• Microsurgery
• Hand surgery

Background:

• Extensive soft tissue loss in the hand and upper extremity presents significant reconstructive challenges.
• Abdominal-based pedicled flaps (groin, Scarpa's fascia, paraumbilical perforator) have been traditional treatment options.
• These flaps offer pliable coverage but have drawbacks like limited mobility and bulkiness.

Purpose of the Study:

• To review the remaining indications for abdominal-based pedicled flaps in hand and upper extremity reconstruction.
• To highlight scenarios where advanced techniques like microsurgery are not suitable or available.
• To provide case examples illustrating these specific indications.

Main Methods:

• Review of existing literature on abdominal-based pedicled flaps for upper extremity reconstruction.
• Analysis of specific clinical scenarios where these flaps are still indicated.
• Presentation of illustrative case examples.

Main Results:

• Microsurgery, regional flaps, and skin substitutes have reduced the use of abdominal flaps.
• Key indications persist, including patient/facility factors precluding microsurgery, absent recipient vessels, prior vessel use, vessel preservation needs, and large multi-surface defects.
• Case examples demonstrate successful application in these specific scenarios.

Conclusions:

• Abdominal-based pedicled flaps retain a crucial role in specific, complex hand and upper extremity reconstructions.
• Their continued utility is demonstrated in situations where advanced reconstructive options are limited or contraindicated.
• Understanding these niche indications is vital for comprehensive reconstructive planning.