Dr. R. Sridhar


AIM : Upper limb injuries are invariably associated with significant soft tissue loss, often requiring flap cover. For forearm and elbow defects
reconstructive options should ensure coverage of larger defects and be less cumbersome for the patient. In this study, the aim is to study the
application of pedicled thoracoumbilical flap for forearm and elbow defects and its outcome.
MATERIALS AND METHODS : Between June 2015 and June 2018, 20 cases of pedicled thoracoumbilical flaps were performed. All patients
were males. Age group ranged from 6 years to 56 years. Defect size varied from 20 sq cms to 350 sq cms. Paraumbilical perforators from the deep
inferior epigastric vessels supplies the skin island of the flap. All patients underwent flap division and inset at 3 weeks. Followup period ranges
from 4 months to 3 years.
RESULTS : All flaps survived completely, except one which had marginal necrosis and managed with split skin grafting. Donor site was closed
primarily in 8 patients and with split skin grafting in 4 patients. All donor sites healed well. Scar assessment was done with observer and patient
scale, being on an average of 24 and 20.5 respectively.
CONCLUSION : The thoracoumbilical flap is a safe and a reliable option for large and complex defects of forearm and elbow. It has the capacity to
transfer a large amount of tissue, allowing the damaged limb, during the attached period, to be elevated and hence minimises edema and congestion
and also to receive physiotherapy. Although the working portion of the flap uses the thin, hairless skin over the lateral ribs, the base of the flap is
thick and difficult to tube in all but the thinnest of individuals. The donor scar is much more conspicuous than that of a groin flap. This procedure can
be done, even in centres where microsurgical facilities or expertise is less and can become workhorse flap for proximal forearm and elbow defects.


Forearm And Elbow Soft Tissue Defects; Thoraco-umbilical Flap; Periumbilical Perforators; Deep Inferior Epigastric Artery

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