Arm Flap Research Articles

On a Hunt for the "True" Septocutaneous Perforator: A Histology Cross-Section Study.

Modern trends in reconstructive surgery involve the use of free perforator flaps to reduce the donor site morbidity. The course of perforator vessels has a great anatomic variability and demands detailed knowledge of the anatomical relationships and the variability of the course of the perforators. The numerous modifications to perforator nomenclature proposed by various authors resulted in confusion rather than simplification. In our study, we focused on the hypothesis that a septocutaneous perforator traverses from the given source vessel to the deep fascia adherent to but not to within the septum itself. Sixty-nine septocutaneous perforators from three different limb donor sites (lateral arm flap, anterolateral thigh flap, and radial forearm free flap) were collected from the gross pathology specimens of 14 fresh cadavers. The gross picture and the cross-sections with the histological cross-sections on different levels were examined to determine the position of the vessel to the septal tissue. Of the observed 69 septal perforators, 61 (88.5%) perforators were adherent to but not within the septum. The remaining eight (12.5%) perforators passed through the septum. All these eight perforators were found in multiple different cross-section levels (2 of 19 in lateral arm flap, 3 of 27 in anterolateral thigh flap, and 3 of 23 in radial forearm free flap). Although septocutaneous vessels appear identical macroscopically, microscopically two types of vessels with paraseptal and intraseptal pathways are observed. The majority of these vessels are merely adherent to the septum having a paraseptal pathway, while a minority are within the septum and are "true" septocutaneous perforators. It is advisable to dissect with a piece of the septum in order to avoid damage or injury to the perforator.

Microsurgical Reconstruction with and without Microvascular Anastomosis of Oncological Defects of the Upper Limb.

The choice of the most adequate surgical technique for upper limb defects remains challenging. The aim of this article is to discuss the main microsurgical (pedicled or free) reconstructive options for the post-oncological reconstruction of different anatomical areas of the upper extremity. We reviewed different reconstructive methods reported in the literature needing microsurgical expertise and compared them to our clinical experience, in order to provide further guidance in the choice of different flaps for upper limb soft tissue reconstruction. Six clinical cases, one for each anatomical district, are presented as examples of possible solutions. We report the options available in the literature for post-oncologic upper limb reconstruction, dividing them by anatomical area and type of flap: local flaps, regional flaps, free flaps, and distant pedicled flaps. Our examples of the reconstruction of each anatomical area of the upper limb include one reverse ulnar pedicled perforator flap, one free Antero-Lateral Thigh (ALT) flow-through flap, one perforator-based lateral arm flap, two myocutaneous latissimus dorsi pedicled flaps, and one parascapular perforator-plus flap. In oncological cases, it is important to consider reconstructive options that provide stable tissue and allow for the early healing of the donor and recipient site if the patient needs to undergo adjuvant radiotherapy or chemotherapy. A wider range of flap options is essential when choosing the proper technique according to the patient's needs, surgeon's preference, and logistical possibilities. Perforator flaps combine the advantages of other flaps, but they require microsurgical expertise. Free flap reconstruction remains the gold standard to obtain a better overall and cosmetic outcome in complex and wide defects, where no suitable local pedicled flap option exists. The pedicled latissimus dorsi flap should still be included among the reconstructive options for its strong vascularization, size, and arc of transposition.

An Innovative Approach to Classifying and Treating Axillary Scar Contracture.

Axillary cicatricial contracture is a debilitating condition that can greatly impair shoulder joint function. Therefore, timely correction of this condition is imperative. In light of Ogawa's prior classification of axillary cicatricial contracture deformities, we have proposed a novel classification system and reconstruction principles based on a decade of treatment experience. Our proposed system offers a more comprehensive approach to correcting axillary cicatricial contracture deformities and aims to improve patient outcomes. Our study included 196 patients with a total of 223 axillary cicatricial contracture deformities. The range of shoulder abduction varied between 10 and 120 degrees. Our treatment approach included various methods such as the lateral thoracic flap, transverse scapular artery flap, cervical superficial artery flap, medial upper arm flap, latissimus dorsi flap, Z-shape modification, and the use of local flaps combined with skin grafting. After 2 weeks, the sutures were removed, and patients were instructed to start functional exercises. To categorize the deformities, we divided them into 2 types: axillary-adjacent region cicatricial contracture (type I) and extended area contracture (type II). For each subtype, a specific treatment method was chosen based on a designed algorithm decision tree. Out of the total cases, 133 patients underwent treatment with various types of local flaps, including Z-plasty, whereas 63 patients received treatment involving skin grafting and different types of local flaps. At the time of discharge, the abduction angle of the shoulder joint ranged from 80 to 120 degrees. Among the 131 patients who were followed up, 108 of them adhered to a regimen of horizontal bar exercises. After a 1-year follow-up period, the abduction angle of the shoulder joint had significantly improved to a range of 110-180 degrees. We have proposed a novel classification method for the correction of axillary cicatricial contracture deformity. This approach involves utilizing distinct correction strategies, in conjunction with postoperative functional exercise, to ensure the effectiveness of axillary reconstruction.

Ortho-oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft-tissue defects after oncologic resections.

Malignant tumors of the foot are rare, and treatment strategies are challenging considering the complex anatomy of this area. In recent years, dramatic advances in technology and collaborations between different specialties (such as orthopedic, oncology, radiology, plastic, and vascular surgery) significantly changed the approach to complex malignant tumors without resorting to limb removal. The combination of the strengths of both orthopedic surgery and plastic surgery constitutes the modern definition of "orthoplasty." The aim of this review article is to provide treatment strategies that are available for reconstruction of foot and ankle in limb-salvage surgery after tumor resection, with a specific focus on microsurgical techniques in plastic surgery. We conducted a comprehensive search for relevant papers across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with small and large soft tissue defects. Indications, pros and cons, and technique tips are discussed for each type of reconstructive technique. The search was done using literature of the past 30 years (from 1990 to date), resulting in about 725 articles describing over 2000 cases. Cutaneous flaps included lateral supramalleolar flap, medial plantar flap, reverse sural neurocutaneous island flap, medial leg flap, and lateral leg flap. Free flaps included anterolateral thigh flap, radial forearm flap, latissimus dorsi flap, gracilis muscle flap, lateral arm flap, and rectus abdominis flap. The orthoplastic approach in musculoskeletal oncology is a collaborative model of orthopedic and plastic surgeons working together, resulting in a higher rate of successful limb salvage in patients at risk for amputation. Protocols, biologic substitutes, and surgical techniques are largely improved in the last decades increasing the possibility of functional reconstruction. Microsurgical strategies represent the new frontiers in these demanding reconstructions.

Sizeable Facial and Cervical Defect Repair using a Medial Arm Flap Combined With the Tissue Expansion Technique: Clinical Applications and Fifteen-year Follow-up.

The aim of this study was to present the 15-year clinical results using a preexpanded pedicle medial arm flap for repairing massive facial and cervical defects. The process of our method is divided into 3 stages. In the first stage, the rectangle-shaped tissue expander was implanted subcutaneously in the medial arm region and serially inflated for ~3 months. In the second stage, the distal portion of the flap was to cover the defects, the proximal portion was overlapped with the residual lesion flap. The pedicle was divided 3 weeks later, and the extra tissue was reinserted back to the donor site. A total of 27 patients were retained. All donor sites were closed directly. Maximum and minimum sizes of preexpanded cervical flaps were 2015cm2 to 5.54cm2. In 2 cases, partial necrosis occurred at the distal end of the flap, while the remaining flap survived completely. The median duration of follow-up was 7.5 years. During follow-up, 24 patients (88.9%) had satisfactory outcomes and 3 patients (11.1%) had partially satisfactory results. Using expanded pedicle medial arm flap for face or neck defects' reconstruction showed that it was safe and effective, and had satisfying results in the long-term follow-up. The flap based on the proximal pedicle has a more reliable blood supply.

Scalp reconstruction with locoregional and free flaps - a retrospective cohort study.

Scalp defect reconstruction requires interdisciplinary cooperation to restore soft tissue and osseous defects. While wound closure and form restoration, often a short-term treatment goal, ensures patient survival, the long-term preservation of the head and neck's integrity and aesthetics is crucial for maintaining quality of life. This study aims to compare, quantify, and establish a safe and reproducible approach to various reconstruction options and the postoperative complication profile for individual scalp defect areas. We retrospectively evaluated patients who underwent scalp reconstruction at our institution between March 2017 and April 2022. The inclusion criterion was the presence of a soft tissue defect at the cranium level. We included 31 patients in the study (17 males, 14 females), with an average age of 61 years (range 17-92 years). Eight patients had received radiotherapy in the affected region. The mean defect size was 72.5±116 cm2 (range 20-441 cm2), and an average of 3±2 surgeries had been performed before the plastic surgical treatment was initiated. Eleven patients had only a soft tissue defect, while 20 patients had an associated bone defect. Fifteen of these patients received a cranioplasty. The rotation flap was the most frequently used (n=23), with or without split-thickness skin grafting, followed by the free latissimus dorsi muscle flap with split-thickness skin grafting (n=5), and the free lateral arm flap (n=2). Revision surgeries were necessary in 38.7% of cases due to wound healing disorders (n=9), bleeding (n=2), and cerebrospinal fluid leaks (n=1). Eventually, all wounds were successfully closed. Complex scalp defects can be closed using local flaps, thereby restoring aesthetics and tissue integrity. Free flaps remain a reliable solution for extensive defects. Moreover, in cases requiring cranioplasty, careful preoperative planning and an uncontaminated wound are essential for successful treatment.

Mapping of Arterial Perforator to Optimize Lateral Arm Flap Design

Mapping of Arterial Perforator to Optimize Lateral Arm Flap Design

Exploration of the vascular angiosome of the extended lateral arm free flap: A cohort study in cadavers

The lateral arm flap is a highly reliable and versatile fasciocutaneous flap for extremity reconstruction. The flap can be harvested in an extended fashion to include the thin skin of the proximal forearm. In the extended version, the maximum amount of skin that can be harvested from the forearm remains unknown. We performed a cohort fresh frozen cadaver dye injection study to investigate this question. A total of seventeen cadaver flap dissections were performed. Our primary goal was to capture the complete angiosome of the extended lateral arm flap, including length and width. Our secondary goal was to explore how much of the flap can be safely harvested distally, past the lateral epicondyle. The overall mean area of dye staining was 23.48±4.60 cm2, which represents the angiosome of the flap. The dye traveled an average of 3.60±4.94 cm into the forearm, past the lateral epicondyle, which suggests a “safe” zone for distal flap harvest. In conclusion, the extended lateral arm flap is a versatile option for extremity reconstruction and can be safely harvested distal to the lateral epicondyle. There is likely a limit, however, to how far distally the skin paddle can extend, which can be explored in future research.

VARIATIONS IN THE ORIGIN OF PROFUNDA BRACHII ARTERY FROM BRACHIAL ARERTY-SYSTEMATIC REVIEW

Objective: The profunda brachii artery (PBA) is a chief artery in anterior compartment of the arm for the nutritional source. Knowledge of variations in the origin and branching is helpful for the surgeon during catheterization and harvesting of lateral flaps. Methods: During the routine dissection for medical undergraduate students we found variations in the branching pattern of PBA in 72 arms from 36 cadavers in the Department of Anatomy, Viswabharathi Medical College, Penchikalapadu, and Kurnool, over 5 years. We preserved all the variations carefully. Results: We observed PBA in all the cadavers, patterns of origin, branches, and termination were recorded. In 96.9% of cadavers artery arises from the brachial artery (BA), in 1.4% from the axillary artery, and in 1.7% cadavers from a common stem with the superior ulnar collateral arteries. In 11.1% and 16.7% of the cadavers showed duplication and early branching. Conclusion: Humeral fractures and BA catheterization the incidence of duplication and early branching make it vulnerable to inadvertent injury and may complicate lateral arm flaps. Pre-operative angiographic evaluation is therefore recommended.

The Effect of a Suspended Radiation Protection System on Occupational Radiation Doses During Infrarenal EVAR Procedures: A Randomised Controlled Study

To compare the protective effect of Zero Gravity (ZG) with conventional radiation protection during endovascular aneurysm repair (EVAR). Secondly, user experience was surveyed with a questionnaire on ergonomics. This was a single centre, prospective, randomised, two arm trial where 71 consecutive elective infrarenal EVAR procedures were randomised into two groups: (1) operator using ZG and assistant using conventional protection (n= 36), and (2) operator and assistant using conventional radiation protection (n= 35). A movable floor unit ZG system consists of a lead shield (1.0 mm Pb equivalent) for the front of the body and 0.5 mm Pb equivalent acrylic shielding for the head and neck. The ZG also includes arm flaps of 0.5 mm Pb equivalent covering the arm up to the elbow. Deep dose equivalent values, Hp(10) were measured with direct ion storage dosimeters (DIS) placed on various anatomical regions of the operator (axilla, chest, abdomen, and lower leg). Personal dose equivalent values, Hp(3) to eye lenses were measured in the operating and assisting surgeon using thermoluminescence dosimeters. The study was registered at the US National Institute of Health #NCT04078165. Protection with the standard protection was superior in chest (0.0 vs. 0.1 μSv), abdomen (0.0 vs. 0.6 μSv), and lower leg (0.4 vs. 2.2 μSv) (p < .001). On the other hand, the ZG system yielded better shielding for the axilla (1.5 vs. 0.0 μSv) and eyes (6.3 vs. 1.1 μSv) of the operator. The use of ZG hampered the deployment of ancillary shields, which is particularly relevant for protection of the assisting surgeon. Users found ZG more cumbersome than conventional garments, it also impaired communication and reduced field of view. Both ZG and conventional radiation protection reduced radiation exposure. Conventional protection allows better manoeuvrability at the price of wider exposure of the upper arm and axilla. ZG indirectly impaired protection of the assistant.

A Unique Case of Modifying an Old Extended Spreader Costal Graft into a Supportive Structure in a Nasal Alar Reconstructive Surgery – A Case Report

A ten-year-old reconstruction surgery of a total nasal dorsum defect on the right nose involves a medial arm flap and self-rib cartilage, complicated into fibrous tissue retraction, which caused nostril narrowing and asymmetry. This complication was corrected using a combination of a nasolabial flap for a skin coverage and a modified, old rib cartilage graft to create a supportive rim for the newly reconstructive right nasal ala. There is controversy about the advantage of auricular cartilage versus costal cartilage with a gap in academic studies. However, in this case, costal cartilage has shown significant benefits that helped patients to gain the best functional and aesthetic results. In addition, the modification of an old nasal graft for another function is a unique spotlight in our case. Therefore, we report a case about using an old nasal graft for an alternative function, as well as the observed results from the first-stage of this procedure.

Twelve Years of Establishing the Strategies for Tongue Reconstruction.

Reconstruction after resection of malignant tongue tumors remains one of the most difficult problems in head and neck oncology. Recent trends in tongue reconstruction have focused on optimizing speech and swallowing functions and maximizing quality of life. In the recent literature, several reconstructive strategies including regional flaps and free flaps have been described. A case series of 328 patients underwent oral tongue reconstruction between March 2011 and March 2022. Functional evaluation was performed in all patients 3 months after reconstruction (where the patients required no adjuvant radiotherapy) or after radiotherapy. Total flap necrosis was seen in 5 patients with free flap reconstruction (2 radial forearm flaps, 1 lateral arm flap, and 2 anterolateral thigh flaps), 5 patients with infrahyoid myocutaneous flap, and 1 patient reconstructed with a supraclavicular flap. Our success rate is 96.6%; partial flap necrosis was observed in 11 patients with infrahyoid myocutaneous flap and 2 patients with a supraclavicular flap. Most patients with subtotal glossectomy or smaller defects (type II-IVA defects) could communicate on the phone and had the near-normal capacity for an oral diet. The remaining patients (type IVB-V defects) had significantly lower speech scores. The majority of patients could eat liquid and semiliquid foods. Tongue cancer surgery and subsequent reconstruction posed exciting challenges for the surgeon to optimize tongue function and quality of life for patients. Attention to the principles of tongue reconstruction and choosing appropriate flap for each defect achieve better functional results.

Securing perforator flap perfusion by using dynamic infrared thermography (DIRT) in complex traumatic hand surgery – A case report

A complex traumatic hand injury may pose a challenge for the reconstructive surgeon. Perforator flaps provide the surgeon with an option in managing such injuries. Securing perfusion of the perforator flap is essential, as partial, or total flap loss yield poor functional and cosmetic outcome, often requiring reoperation. We report a case of a 28-year -old male suffering a mutilating hand injury after a car accident. Reconstruction was performed with a free microvascular lateral arm flap, and perfusion of the flap was monitored pre-, intra-, and postoperatively with dynamic infrared thermography (DIRT).The purpose of this report is to highlight the usefulness of DIRT as a novel perfusion imaging modality in the management of complex traumatic hand injury. • Dynamic infrared thermography (DIRT) can be used in complex traumatic hand surgery for perforator mapping. • DIRT can be used to evaluate flap perfusion intra- and postoperatively. • DIRT can be used to evaluate patency of the microvascular anastomose. • DIRT is a non-invasive, non-contact imaging modality that provides reliable information on skin perfusion.

Strategies of Total Auricular Reconstruction for Patients With Poor Skin Coverage at the Mastoid Area.

Burns and injuries can lead to massive defects in the mastoid tissues, which increase the difficulty of ear reconstruction. It is crucial to choose an appropriate surgical method for these patients. Here, we introduce strategies for auricular reconstruction in patients without satisfactory mastoid tissues. From April 2020 to July 2021, 12 men and 4 women were admitted to our institution. Twelve patients were severely burned, 3 patients experienced car accidents, and 1 patient had a tumor on his ear. The temporoparietal fascia was used for ear reconstruction in 10 cases, and the upper arm flap was used in 6 cases. All of the ear frameworks were made of costal cartilage. The location, size, and shape of both sides of the auricles were generally the same. Two patients needed further surgical repair because of cartilage exposure at the helix. All of the patients were satisfied with the outcome of the reconstructed ear. For patients with ear deformity and poor skin coverage in the mastoid area, we can choose the temporoparietal fascia if the patient's available superficial temporal artery is longer than 10cm. If not, we can choose the upper arm flap. The latter needs a five-stage operation, which is more time consuming and difficult than the former. Moreover, the expanded upper arm flap is thinner and has better elasticity than the temporoparietal fascia, so the shape of the reconstructed ear is better. We need to evaluate the condition of the affected tissue and choose the appropriate surgical method to achieve a good result.

Hand Injuries at Work: Causes, Spectrum and Management

Background: Hand injuries are common and an increased surge has been seen secondary to the use of machines.The spectrum of injuries is wide ranging from injuries requiring few stitches to requiring specific reconstructive procedures such as skin grafting, pedicled flaps to free flaps or amputations depending on severity and pattern of injury. Methods: This was a hospital-based single-arm prospective study conducted in the Department of Plastic and Reconstructive Surgery for 3 years. 46 patients were included.Each record was analyzed as per the etiology, the treatment received, the reconstructive procedures done, and the functional and aesthetic outcomes. Results: Most of the affected individuals were young, the mean age of the patients was found to be 23 years. Among the injured 85% were males. The dominant hand (right hand) was more frequently injured in 74% of cases. In total 18 patients had some of the affected areas amputated; this included formalization of traumatic amputations. It is also significant that twelve patients underwent revascularization and four reimplantations. Twelve patients underwent groin flaps as a primary or delayed primary in the same admission. Ten patients required split skin grafting and three. Two patients were managed with FDMA flap for thumb defect, one patient was managed with reverse radial forearm flap for compound defect dorsum of thumb, and another with free lateral arm flap for compound defect of thumb. Conclusion: The management of machine injuries of the upper limb and hand requires specific and unique methods of treatment. A "reconstructive ladder" of techniques was utilized, ranging from "simple" (e.g., direct closure, skin grafts, and local flaps) to "complex" (free flaps, toe-to-thumb transfer) procedures. The individual procedure selected is the most straightforward, consistent with expediency and early return of a functional hand. The return of these hands to function has been facilitated by recent advances in tissue assessment, free tissue transfer, and skilled hand therapy. Keywords: Dominant hand, machine injury, band saw, brush cutter, rotator drill.

Comparison of lateral arm flap and posterior interosseous artery flap for soft tissue reconstruction of the elbow.

The study aimed to evaluate and compare the two different flap techniques used for the reconstruction of soft tissue defects in the elbow region: the lateral arm flap (LAA) and posterior interosseous artery (PIA) flap. The retrospective study included 12 patients who underwent surgical treatment for soft tissue defects between 2012-2018 at the clinic. The study evaluated demographic data, flap size, operating time, donor site, flap complications, number of perfora-tors, and functional and cosmetic outcomes. Results showed that patients who underwent PIA flap had significantly smaller defect size than those who underwent LAA flap (p<0.001). However, there were no significant differences between the two groups (p>0.05). Patients who received PIA flaps had significantly lower QuickDASH scores, indicating better functional results (p<0.05). The operating time was significantly shorter in the PIA group than in the LAA flap group (p<0.05). Additionally, the range of motion (ROM) of the elbow joint was significantly higher among the patients who received the PIA flap (p<0.05). The study concludes that both flap techniques are easy to apply depending on the surgeon's experience, have low complication risk, and provide similar functional and cosmetic results in similar defect sizes.

Reconstruction of the Axillary Region after Excision of Hidradenitis Suppurativa: A Systematic Review.

Introduction Hidradenitis suppurativa (HS) is a chronic, debilitating, recurrent, auto-inflammatory disease of the pilosebaceous units of the skin. The axillary region is the most affected anatomical site and its reconstructive options include skin grafts, local random plasties, regional axial flaps, and regional perforator flaps. The main aim of this systematic review is to identify the best surgical technique for axillary reconstruction in the context of HS, in terms of efficacy and safety. Methods We adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) throughout the whole review protocol build-up. The literature search was performed using MEDLINE, Embase, and Cochrane library databases, updated to March 2021. Quality was assessed for each study, through the National Institutes of Health Quality Assessment Tool. Results A total of 23 studies were included in the final analysis. We reviewed a total of 394 axillary reconstructions in 313 patients affected by HS Hurley Stage II or III. Skin grafts were associated with the highest overall complication rate (37%), and highest rate of reconstruction failure (22%). Between thoraco-dorsal artery perforator flap, posterior arm flap, and parascapular flap, the latter showed fewer total complications, recurrences, and failures. Conclusion Regional axial flaps should be considered as the best surgical approach in the management of advanced HS. The parascapular flap emerges as the most effective and safest option for axillary reconstruction. Local random flaps might be considered only for selected minor excisions, due to the higher risk of recurrence. The use of skin grafts for axillary reconstruction is discouraged.

Reconstruction of Multiple Digital Defects by Temporary Syndactylization Using a Lateral Arm Free Flap.

Background Soft tissue defects of the multiple finger present challenges to reconstruction surgeons. Here, we introduce the use of a lateral arm free flap and syndactylization for the coverage of multiple finger soft tissue defects. Methods This retrospective study was conducted based on reviews of the medical records of 13 patients with multiple soft tissue defects of fingers ( n = 33) that underwent temporary syndactylization with a microvascular lateral arm flap for temporary syndactylization from January 2010 to December 2020. Surgical and functional outcomes, times of flap division, complications, and demographic data were analyzed. Results Middle fingers were most frequently affected, followed by ring and index fingers. Mean patient age was 43.58 years. The 13 patients had suffered 10 traumas, 2 thermal burns, and 1 scar contracture. Release of temporary syndactyly was performed 3 to 9 weeks after syndactylization. All flaps survived, but partial necrosis occurred in one patient, who required a local transposition flap after syndactylization release. The mean follow-up was 15.8 months. Conclusion Coverage of multiple finger defects by temporary syndactylization using a free lateral arm flap with subsequent division offers an alternative treatment option.

Thumb reconstruction after radical tumor resection using free osteocutaneous lateral arm flap with secondary humerus fracture—a case report

IntroductionMalignant diseases with infiltration of bony structures in the area of the phalanges or metacarpals require either amputation or complex reconstruction. The decision for reconstruction means to restore length, mobility, sensibility, stability as well as aesthetics.MethodsWe present a case of complex first ray reconstruction of the left hand using a free osteocutaneous lateral arm flap from the ipsilateral side. The reconstruction was performed after radical resection of an exulcerated squamous cell carcinoma, including the first metacarpal bone, trapezium, partial trapezoid and distal scaphoid as well as partial resection of the extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus and flexor carpi radialis tendons. The osteosynthetic restoration was achieved distally by a double wire cerclage and a proximally by temporary K-wire suspension. Moreover, to reconstruct the extensor pollicis longus tendon the ipsilateral palmaris longus tendon was harvested and used. Postoperatively, a secondary humerus fracture occurred, which was initially attended by plate osteosynthesis. The fracture showed delayed healing, which was treated by re-plating and autologous cancellous bone.Results12 months postoperatively, the patient showed an excellent outcome with length preservation and good range of motion, sensibility, stability and aesthetic of the thumb. Furthermore, the quarterly tumor aftercare showed no evidence of recurrence.ConclusionThis case report showed that the free osteocutaneous lateral arm flap is a reliable solution for the reconstruction of the first ray with a great functional and aesthetic outcome. To prevent a secondary humerus fracture, a preventive plate osteosynthesis simultaneous with the osteocutaneous flap elevation should be considered.

Facial and Neck Reconstruction With Pre-expanded Medial Upper Arm Flap: An Alternative method and 20-Year Experience.

To present our experience with pre-expanded medial upper arm flap in facial and neck reconstruction. This was a retrospective study operated between January 1st, 2001 and January 1st, 2021, at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College. Staged face and/or neck reconstruction was performed. Forty-one patients were treated in our institution and thirty-eight patients (forty-three flaps) were included in this cohort as. They ranged from 6 to 44 years old. There was no total flap loss in the cohort. Partial flap necrosis was observed in the earlier patients (4 cases). Pre-expanded medial upper arm flap is well matched to the facial and neck skin in color, texture, and thickness. Considering the excellent aesthetic outcomes, this flap is a good alternative for selected patients with soft tissue defects of the head and neck.