Combination of a Total Free Forearm Flap and a Sensate Local Flap for Preservation of the Shoulder Girdle in Massive, Nonreplantable Upper Extremity Injuries

Abstract

This challenging procedure helps to achieve durable and sensate coverage of bony prominences. The use of local sensate tissue to cover bony prominences reduces the risk for pressure ulceration when wearing a prosthesis. Areas where prosthetic use causes only low pressure and shearing forces are adequately covered with free flaps. Immediate sensibility of local flaps allows prosthetic fitting and use as soon as wound healing has occurred. Return to work is thus expedited.

Defect Coverage after Forequarter Amputation—A Systematic Review Assessing Different Surgical Approaches

“…A common consequence of the radical ablation of the arm and the anatomical structures of the shoulder girdle is the requirement of a subsequent microsurgical reconstruction in order to enable adequate defect coverage and wound closure. The "spare-parts concept", which utilizes tissue from the amputated limb to reconstruct a defect without creating additional donor side morbidity (i.e., fillet flap), is a recognized technique in reconstructive and traumatic surgery [7,15,[27][28][29]. Küntscher and colleagues provided a thorough overview of this surgical technique in an extensive study on 104 fillet flaps.…”