Application of bipedicled massive cross arm flap with dual blood supply for repair of forearm soft tissue defects

Abstract

Objective To introduce a procedure and application of bipedicled latissimus dorsi and thoraco umbilical flap with dual blood supply, and to discuss the operative indication and key technology of massive long narrow flap for repair of forearm soft tissue defects. Methods From January 2009 to December 2011, 3 patients with forearm and hand soft tissue defects were treated by bipedicled latissimus dorsi and thoraco umbilical flap with dual blood supply. The flap area ranged from 25 cm×12 cm to 42 cm×10 cm. Double sets of arteriovenous were applied. The dorsal thoracic artery and vein were anastomosed to the ulnar or radial proximal artery and vein of the forearm, respectively, at the proximal of flap. The inferior epigastric artery and vein were anastomosed to the contralateral radial artery and vein, respectively, at the distal of flap. Both arms were fixed crossly. The distal pedicle was separated from contralateral upper limb 3 weeks after the operation. Results Three cases of flap all survived with upper limb retention. All the patients were follow-up for 8 to 36 months. Flap color, texture and forearm shape were good. Wrist and hand function partially recovered. The protective sensation of the flaps also recovered. Conclusion According to the principle of latissimus dorsi muscle and thoracic umbilical flap combined with double segment arterial blood supply, it can be designed as a huge long and narrow flap. It is a practical surgical method for repair of upper limb large soft tissue defects due to large area cutting, surgical safety and minor damage to donor sites. Key words: Surgical flaps; Forearm injuries; Double blood supply