Upper-extremity free skin flap transfer: results and utility as compared with conventional distant pedicle skin flaps

A group of patients who underwent free skin or muscle flap transfer to the upper extremity are compared with a similar group who were treated by a conventional distant pedicle skin flap. The most frequent indications for using a free flap technique were the presence of an exoskeletal fixation apparatus at the recipient site which precluded a more conventional procedure, or the desire to obtain an innervated flap for sensibility. The free flap group generally had more massive defects. In this group, the mean initial surgical time was 5.37 hours and total cost was $7,692. An average of 1.58 general anesthetics was required, and the mean postoperative hospitalization was 13.08 days. In the conventional distant pedicle flap group, mean initial surgical time was 2.76 hours and total cost was $6,849. An average of 2.54 general anesthetics was required and mean postoperative hospitalization was 19.15 days. All cases had a successful outcome, although the complication rate was slightly higher in the free flap group. Overall, the economic advantage was slightly weighted toward the conventional pedicle flap group, although hospitalization time was longer. Therefore, for the management of soft tissue defects in the upper extremity requiring pedicle flap coverage, a free flap should probably be chosen only for specific indications and special circumstances.