Beyond function: Aesthetic considerations in pedicled abdominal flaps for upper limb reconstruction

Pedicled abdominal flaps (PAFs) represent an established approach for reconstructing the upper extremity, offering robust coverage and minimal donor-site morbidity. Most studies focus on functional outcomes and complications; however, there is a paucity of literature examining patient and physician satisfaction regarding aesthetic results following reconstruction.

This retrospective study aimed to assess pedicled abdominal flap efficacy and safety in upper limb reconstruction, examining flap survival, complications, aesthetic outcomes, and surgeon assessment.

The study included 16 patients who underwent reconstruction using PAFs between January 2022 and February 2025. The distribution of vascular territories used for flap reconstruction was as follows: (SIEA) alone in one case (6.3 %), (SCIA) in eight cases (50 %), (PUP) flap in five cases (31.3 %), and a combination of SIEA + SCIA in two cases (12.5 %). Aesthetic outcomes were assessed via patient and physician satisfaction surveys. Additionally, complications and donor-site morbidity were analyzed.

The surgical outcomes demonstrated a high flap survival rate of 93.8 %, indicating generally favorable results. Wound infection occurred in 25 % of cases. Physicians generally reported higher satisfaction levels across most domains than patients, although both groups exhibited acceptable results. No major donor-site morbidity was observed.

PAFs represent a reliable and efficient method for upper limb reconstruction, achieving favorable aesthetic outcomes with high flap survival and low complication rates. Notably, aesthetics emerged as a critical outcome domain, with patient and Physician evaluations highlighting their importance.