In the Era of Advanced Microsurgery, Is There Still a Place for Pedicled Abdominal Flaps? A Retrospective Analysis

Background: Upper extremity reconstruction poses a significant challenge due to the complex anatomical and functional requirements of the hand and forearm. While free flaps have become the gold standard, pedicled abdominal flaps remain a valuable alternative, especially in cases where microsurgical anastomosis is contraindicated or unfeasible. This study evaluates the efficacy and outcomes of free-style pedicled abdominal flaps in reconstructing complex upper limb defects. Methods: A retrospective review was conducted on 20 patients who underwent soft tissue reconstruction of the upper extremity using free-style pedicled abdominal flaps between January 2019 and June 2024. Patient demographics, injury mechanisms, flap design, postoperative complications, and clinical outcomes were analyzed. Flap design was customized to defect size and location, utilizing single, double, triple, and tunneled flap configurations where necessary. Results: Stable soft tissue coverage was achieved in all cases without the need for additional free flap procedures. Complications included surgical site infections (n = 2), marginal necrosis (n = 2), partial flap necrosis (n = 2), and complete necrosis (n = 2), with no cases requiring free flap conversion. Long-term follow-up revealed no finger stiffness or loss of hand function. Donor site morbidity was minimal, with only one case requiring a split-thickness skin graft for closure. Conclusions: Despite advancements in microsurgical techniques, free-style pedicled abdominal flaps remain a vital reconstructive option for upper limb defects, particularly in patients with complex, large, or circumferential injuries. Their versatility, reliable vascularity, and ability to conform to various defect shapes underscore their enduring relevance in modern reconstructive surgery.