The Versatility of Paraumbilical Perforator Flap in the Coverage of Large Posttraumatic Hand Defects

Setta, Hany S; Al Mahmoudy, Niveen F; Badawy, Mohamed S

doi:10.21608/ejprs.2023.291379

The Versatility of Paraumbilical Perforator Flap in the Coverage of Large Posttraumatic Hand Defects

Document Type : Original Article

Authors

The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University

10.21608/ejprs.2023.291379

Abstract

Background: The use of pedicled distant flaps remains
of significant importance in the reconstruction of the complex
soft tissue defects of the upper extremity.
Objective: In this article, we present contralateral paraumbilical
perforator pedicled flap for reconstructing complex
soft tissue defects of the hand with or without distal forearm.
Patients and Methods: Twenty patients (19 men, 1 woman)
had contralateral paraumbilical perforator pedicled flaps for
the reconstruction of complex soft tissue defects of the hand
with or without distal forearm. Patients' age ranged between
16 and 52 years (mean age was 38.4 years). Flaps size,
dimension and orientation were designed individually for
each defect and ultrasound Doppler was used for perforator
marking. Flap pedicle division was done after 3 weeks after
the first operation. Donor areas were closed directly in all
patients with a follow up of 6-month duration.
Results: In all the twenty cases, the flaps survived completely
without having any major complication postoperatively
except for two cases of seroma, three cases of wound disruption
and only one case of distal flap necrosis. Flap dimensions
ranged from 6x10 to 16x26cm. The surgical outcome was
found to be functionally and aesthetically satisfactory during
the follow-up period.
Conclusion: Paraumbilical perforator pedicled flap is a
reliable surgical option for the reconstruction of complex soft
tissue defects of the hand with or without distal forearm. The
contralateral paraumbilical perforator flap should be a considerable
alternative in hand reconstruction due to its ease of
application, with no need for specialized equipment (no
available microsurgery), low donor site morbidity with satisfactory
functional and aesthetic outcomes.

Main Subjects

Flaps

References

Goertz O., Kapalschinski N., Daigeler A., Hirsch T.,
Homann H.H., et al.: The effectiveness of pedicled groin
flaps in the treatment of hand defects: Results of 49
patients. J. Hand Surg. Am., 37 (10): 2088-2094, 2012.
2- Al Qattan M.M. and Al-Qattan A.M.: Defining the indications
of pedicled groin and abdominal flaps in hand
reconstruction in the current microsurgery era. J. Hand
Surg. Am., 41 (9): 917-927, 2016.
3- Barillo D.J., Arabitg R., Cancio L.C. and Goodwin C.W.:
Distant pedicle flaps for soft tissue coverage of severely
burned hands: An old idea revisited. Burns, 27 (6): 613-
619, 2001.
4- McGregor I.A. and Jackson I.T.: The groin flap. Br. J.
Plast. Surg., 25: 3-3.16, 1972.
5- Hester T.R., Nahai F., Beegle P.E., et al.: Blood supply
of the abdomen revisited, with emphasis on the superficial
inferior epigastric artery. Plast. Reconstr. Surg., 74: 657-
66, 1984.
6- Koshima I., Moriguchi T., Fukuda H., et al.: Free, thinned,
paraumbilical perforator-based flaps. J. Reconstr. Micro-
Surg., 7: 313-6, 1991.
7- Taylor G.I., Corlett R.J., Dhar S.C., et al.: The anatomical
(angiosome) and clinical territories cutaneous perforating
arteries: Development of the concept and designing safe
flaps. Plast. Reconstr. Surg., 127 (4): 1447-1459, 2011.
8- Yilmaz S., Saydam M., Seven E. and Ercocen A.R.:
Paraumbilical perforator-based pedicled abdominal flap
for extensive soft-tissue deficiencies of the forearm and
hand. Ann. Plast. Surg., 54: 365-8, 2005.
9- Hosny H., Kadry H.M. and El-Sharkawy O.A.: The use
of distal ulnar artery perforators in the coverage of wrist
and hand defect. Med. J. Cairo Univ., 84 (2): 407-412,
2016.
10- Ravikiran N., Shashank C., Aniket D., et al.: Reconstruction
of post-traumatic upper extremity soft tissue defects with
pedicled flaps: An algorithmic approach to clinical decision
making. Chin. J. Traumatol., 21 (6): 338-351, 2018.
11- Chung K.C. and Cederna P.S.: Endoscopic harvest of
temporoparietal fascial free flaps for coverage of hand
wounds. J. Hand Surg., 27A: 525-533, 2002.
12- Chung K.C. and Tong L.: Use of three free flaps based
on a single vascular pedicle for complex hand reconstruction
in an electrical burn injury: A case report. J. Hand
Surg., 26A: 956-961, 2001.
13- Yildirim S., Taylan G., Eker G. and Aköz T.: Free flap
choice for soft tissue reconstruction of the severely damaged
upper extremity. J Reconstr. Microsurg., 22: 599-
609, 2006.
14- Gupta A., Chrisovalantis L., Beng H., et al.: Free tissue
transfer to the traumatized upper extremity: Risk factors
for postoperative complications in 282 cases. J. Plast.
Reconstr. Aesthet. Surg., 68 (9): 1184-1190, 2015.
15- Choi J.Y. and Chung K.C.: The combined use of a pedicled
superficial inferior epigastric artery flap and a groin flap
for reconstruction of a dorsal and volar hand blast injury.
Hand (NY), 3: 375e80, 2008.
16- Kadry M., Noureldin A.A. and Khalifa I.G.: The Extended
Deep Inferior Epigastric Flap: A Spearhead to Charge
into the Most Resistant Sites M. Masellis et al. (eds.),
The Management of Burns and Fire Disasters: Perspectives
2000 © Kluwer Academic Publishers, 68: 389-395, 1995.
17- Kamath B.J., Verghese T. and Bhardwaj P.: “Wing flaps”:
perforator based pedicled paraumbilical faps for skin
defects in hand and forearm. Ann. Plast. Surg., 59: 495-
500, 2007.
18- Taylor G.I., Corlett R. and Boyd J.B.: The extended deep
inferior epigastric flap: A clinical technique. Plast. Reconstr.
Surg., 72: 751-65, 1983.
19- Boyd J.B., Taylor G.I. and Corlett R.: The vascular
territories of the superior epigastric and the deep inferior
epigastric systems. Plast. Reconstr. Surg., 73: 1-16, 1984.
20- Luke G., Gregory A. and Kevin R.: Paraumbilical Perforator
Flap for Soft Tissue Reconstruction of the Forearm
J. Hand Surg. Am., 40 (3): 586-592, 2015.
21- Kristina D., Vinay R., John B. and Gregory A.: Oblique
Pedicled Paraumbilical Perforator-Based Flap for Reconstruction
of Complex Proximal and Mid- Forearm Defects:
A Report of Two Cases J. Hand Surg., 35A: 1105-1110,
2010.