Flap Decisions and Options in Soft Tissue Coverage of the Upper Limb

Abstract

Soft tissue deficiency in the upper limb is a common presentation following trauma, burns infection and tumour removal. Soft tissue coverage of the upper limb is a challenging problem for reconstructive surgeons to manage. The ultimate choice of soft tissue coverage will depend on the size and site of the wound, complexity of the injury, status of surrounding tissue, exposure of the vital structures and health status of the patient. There are several local cutaneous flaps that provide adequate soft tissue coverage for small sized defects of the hand, forearm and arm. When these flaps are limited in their mobility regional flaps and free flaps can be utilised. Free tissue transfer provides vascularised soft tissue coverage in addition to the transfer of bone, nerve and tendons. Careful consideration of free flap choice, meticulous intraoperative dissection and elevation accompanied by post-operative physiotherapy are required for successful outcomes for the patient. Several free flaps are available for reconstruction in the upper limb including the groin flap, anterolateral flap, radial forearm flap, lateral arm flap and scapular flap. In this review we will provide local, regional and free flap choice options for upper limb reconstruction, highlighting the benefits and challenges of different approaches.

The Use of Regional Flaps for the Repair of Synovio-Cutaneous Fistulas of the Shoulder after Attempted Rotator Cuff Repair: A Report of Two Cases

“…Previously reported flaps used for local coverage of deep shoulder wounds following rotator cuff repair include the latissimus dorsa and pectorals major, both of which have been reported to have favourable outcomes [29][30][31]. Modern reconstructive literature indicates that utilization of well vascularized fasciocutaneous flaps is equivalent to use of a muscle flap for wound coverage, and the choice of the regional flap is at the discretion of the reconstructive surgeon [32][33][34][35][36].…”

Primary tumors of the hand: Functional and restorative management

“…As a last resort, the harvest and use of spare parts from amputated segments can be used for wound closure and restoration of function . These options have been described in the literature at length and are outside the scope this review . In general, the reconstructive ladder (Figure ) should be followed, as the ladder accommodates not only the wound type but also the surgeon's skill level and available resources.…”

“…85,86 These options have been described in the literature at length and are outside the scope this review. 60,[87][88][89][90][91][92][93] In general, the reconstructive ladder ( Figure 1) should be followed, as the ladder accommodates not only the wound type but also the surgeon's skill level and available resources.…”

A brief history of topographical anatomy

“…9). The principles of three-dimensional vascular anatomy revealed by their meticulous studies determine the choice of appropriate perforator flap, whether musculocutaneous (indirect) or septocutaneous (direct), used to reconstruct soft tissue defects (see Inoue & Taylor, 1996;Houseman et al 2000;Taylor et al 2011Taylor et al , 2012Griffin et al 2014;Jordan et al 2014).…”