Opposite-Running Double Abdominal Flap on Single Pivot Point (Udaipur Flap) for Circumferential Coverage of Wrist and...

Complete or near circumferential defects over wrist and hand are difficult situations. They need flaps so long that available adjacent, distant or free flaps often seem inadequate. Hence, this innovative solution was designed. Twin axial flaps were elevated along an oblique axis over abdomen, extending in opposite directions while being pedicled and pivoted at about the same transverse plane. The flaps wrapped the limb from either side and gave complete coverage. Donor sites were closed directly or skin grafted. Three weeks later flap division was done, often after a delay procedure. The technique was used in 6 cases. All patients were young males with history of electrical burns or trauma resulting in total or near circumferential defect. Required length of flaps ranged from 15 to 26 cm with length/breadth ratio ranging from 3:1 to 5:1. Double abdominal flaps could cover all the exposed structures. Limb positioning was comfortable. All flaps survived; all limbs were salvaged. The cover was soft, supple, and pinchable. This is a simple yet effective flap design to address the difficult problem of circumferential defects at hand. The conceptualization and success of this flap system may be attributed to the understanding of patterns of cutaneous vasculature discovered by Ian Taylor. When the vascular axes in a region are known, the same can be exploited to design more than 1 flap in desired orientation. In conclusion, this "Undulate-design Double Abdominal flaps Insertion-Pouch for Upper limb Reconstruction" is a new and effective solution for circumferential defects of wrist and hand.