Reconstruction of Circumferential Upper Extremity Defect Using a Bipedicle Expanded Flank Flap.

Abstract

Resurfacing of extensive upper extremity lesions remains a challenge for plastic surgeons because of optimal functional and aesthetic outcomes and limitations of flap size. We introduced a pre-expanded flank flap to reconstruct the circumferential upper extremity defect in one sequence of tissue expansion. Between March 2015 and June 2019, 14 consecutive patients underwent reconstructive treatment for circumferential soft tissue lesions in the upper extremity using a bipedicle expanded flank flap. Surgical treatment was divided into 3 stages consisting of expander implantation in the flank area, bipedicle flap transfer to resurface the skin lesion on upper extremity, and flap pedicle transection. Flap survival, complications, and functional and aesthetic outcomes were evaluated. Fourteen patients with circumferential upper extremity lesions were enrolled in this study, 2 of them were diagnosed as extensive scar and 12 of them as giant congenital melanocytic nevi. Twelve patients completed more than 6-month follow-up. One or 2 tissue expanders were implanted in flank, lateral thorax, or abdomen area. The average time of tissue expansion was 25.9 weeks. The pedicled thoracoabdominal flaps were used to resurface a mean skin defect area of 406.6 cm2 ranging from 252 to 660 cm2. In all cases, primary donor site closure was achieved. Seroma developed in 1 case after flap transferred. With aspiration, the flap survived completely. No marginal necrosis was seen. The reconstructed limbs showed satisfactory outcome in both aesthetic and functional aspects. The bipedicle expanded flank flap enables reconstruction of circumferential upper limb skin lesions in 1 sequence of tissue expansion with low complication rate and high patient satisfaction.