Reconstruction of forearm and elbow defects by pedicled periumbilical perforator based Thoracoabdominal flap : an alternative to free flaps

We evaluated the outcome of thoracoabdominal flap coverage of a large defects in the upper limb, especially around the elbow joint and forearm for its reliability, and early and late post-op outcome in 15 patients. All require this flap for indications, additional procedures, and complications. Injuries to the upper limb are associated with significant soft tissue loss requiring coverage. Local tissue/flap options may not be available to cover the defect necessitating the import of tissue from a distant source as the flap. The mean size of the flap in this study was 56 cm² (range 20 cm²–150 cm² ). This flap is based on the perforators of the deep inferior epigastric artery that are maximally centered on the periumbilical region 1. The patients were observed for at least 3 weeks for any flap or donor site complications. The patients were again followed up at 3 months intervals and the donor site scar was also assessed. The flaps survived in all patients except for marginal necrosis in three patients. One of these patients required an additional procedure for coverage. The flap is technically easy to plan and it drapes around upper limb defects, with no significant donor site morbidity. Thus this flap is very useful in coverage of the upper limb and recommended as a first-line flap for coverage of large hand, forearm, and elbow defects. Competent upper limb physiotherapy is recommended to get optimal results.