The ‘buddy flap’ concept of soft-tissue-defect reconstruction

Abstract

Closure of donor-site defects from large cutaneous flap harvesting often faces significant morbidity, which limits the utility of workhorse flaps in large-soft-tissue defect reconstruction. To overcome this limitation, we introduced the concept of a second 'buddy' flap to reconstruct the donor-site defect. Between 2007 and 2010, the buddy flap concept was applied in 12 patients. In each case, the primary flap, which included the latissimus dorsi myocutaneous flap, parascapular flap, transverse rectus abdominis myocutaneous flap, superficial inferior epigastric artery flap and anterolateral thigh flap, was transferred to repair the primary defect. In addition, a secondary pedicle flap, either an axial flap or a perforator flap, was chosen as a buddy flap for closure of the donor-site defect. The primary defects ranged from 10 × 7 to 35 × 20 cm in size. Donor-site closure was accomplished using buddy flaps with preserved normal contour and acceptable scars. Additional time for the buddy flap harvesting and insetting was within 1 h. All flaps survived completely. There were three cases with complications, such as seroma, wound infection and haematoma, which were managed accordingly without compromising the viability of flaps. The buddy flap approach achieved reliable coverage of large donor-site defects with low morbidity and excellent aesthetic results. This technique allows reconstructive surgeons to harvest large cutaneous flaps without being limited by significant donor-site morbidity. We demonstrate that this technique can diminish the concern regarding donor-site defect in large soft-tissue reconstruction.