Defect Coverage after Forequarter Amputation-A Systematic Review Assessing Different Surgical Approaches.

Area of Science:

• Surgical Oncology
• Reconstructive Microsurgery
• Orthopedic Surgery

Background:

• Forequarter amputation (FQA) necessitates complex reconstruction for large defects, often due to malignancy or trauma.
• Autologous osteomusculocutaneous fillet flaps are a recognized reconstructive method.
• Osseous inclusion in fillet flaps presents distinct advantages for reconstruction.

Purpose of the Study:

• To systematically review reconstructive options for FQA using osteomusculocutaneous fillet flaps.
• To emphasize personalized surgical techniques and evaluate outcomes.
• To present a case utilizing targeted muscle reinnervation (TMR) with a fillet flap.

Main Methods:

• Systematic literature search of PubMed and Cochrane databases.
• Inclusion criteria focused on studies detailing FQA reconstruction with osteomusculocutaneous fillet flaps.
• Analysis of four relevant studies encompassing 10 cases.

Main Results:

• FQA was primarily indicated for advanced local malignancy.
• Common vascular anastomoses involved the brachial artery and brachial/cephalic vein to subclavian vessels.
• A case demonstrated successful forearm fillet flap reconstruction with TMR for an extensive osteosarcoma, resulting in no phantom limb pain.

Conclusions:

• Osteomusculocutaneous fillet flaps are a safe and advantageous choice for free flap reconstruction after FQA.
• Forearm flaps are recommended when elbow joint inclusion is not feasible.
• Targeted muscle reinnervation (TMR) is advocated to potentially mitigate phantom limb and neuroma pain.