The role of pedicled abdominal flaps in hand and forearm composite tissue injuries: Results of technical refinements for safe harvest

Abstract

We evaluated the outcome of new technical refinements in abdominal flap coverage of major defects in upper limb for its reliability and safety. 68 patients were assessed for indications, additional procedures, complications and DASH questionnaire evaluation at the end of a year. The mean size of flap was 56 cm 2 (range 6-250 cm 2). Median DASH score was 11.5 (range: 0-63). Hand stiffness was observed in 39% of patients. However, this was absent in whom prophylactic pinning of metacarpophalangeal joints were done in James position. Abdominal flaps give satisfactory results in hand injuries. Competent hand therapy program is essential to get best results.

Pedicled Abdominal Flaps for Hand Reconstruction in Adults: Physiotherapy of the Attached Hand

“…Several authors have stressed technical tips to ensure a successful reconstruction of hand defects with pedicled abdominal flaps. 4 , 8 These tips include adequate debridement, respect of the vascular territory of the flap, minor thinning of the flap at the margins, tubing of the flap if possible, and the use of mattress sutures or simple sutures 1 cm apart. We applied these principles in our cases and prefer to use 3/0 polypropylene interrupted mattress sutures.…”

“… 8 , 13 Complications are known to be more frequently observed in elderly patients, patients with diabetics, smokers, and in the presence of infection. 8 Furthermore, in severe hand trauma, there is a more pronounced hand edema and a higher risk of stiffness. The low rate of complications in our series is probably partly related to several favorable conditions.…”

“…Stiffness of the fingers post-abdominal flap coverage is known to occur mostly at the metacarpophalangeal joints of the fingers. 8 In most previously reported series, the hand is kept flat on the abdomen. The extended interphalangeal joints keep their collateral ligaments stretched, and hence stiffness of these joints has not been a problem.…”

“…In contrast, the extended metacarpophalangeal joints develop contractures and shortening of the collateral ligaments. Achyra et al 8 recommended immobilization of the metacarpophalangeal joints in flexion using K-wires, while the hand is attached to the abdomen, and they found a lower rate of stiffness in these patients compared with those who had no K-wires. Others have tried to divide the abdominal flap early (by gradual or intermittent clamping of the pedicle) to allow early hand physiotherapy.…”

The use of pedicled abdominal flap to salvage a necrotic forearm - a case study

“…When large areas are required for cover, territories of the SCIA, SIEA, and SEPA can be incorporated. 22,23 A common complication which may be experienced with the abdominal flap is marginal flap necrosis, which represents necrosis at the distal edge leading to poor and delayed wound healing. Most of these will heal after regular dressing or secondary suturing after debridement.…”