Soft Tissue Reconstruction of the Hand and Arm-THE USE OF FILLET FLAPS IN UPPER EXTREMITY RECONSTRUCTION

THE USE OF FILLET FLAPS IN UPPER EXTREMITY RECONSTRUCTION

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In cases where there are extensive soft-tissue defects in the upper extremity, major fillet flaps can be used for reconstruction. These flaps can be derived from anatomically intact limbs and can be either pedicled or free flaps. This article discusses the use of fillet flaps based on the experience of using them on selected patients over a 5-year period at two institutions. The etiology of the injury for which these flaps are ideal includes trauma and tumor resection or reconstruction. The locations of the defects that were reconstructed using these flaps included the shoulder, neck, arm, chest wall, upper arm, and forearm.<br /><br />The technique for harvesting fillet flaps of the upper extremity is based on the principles of harvesting free-tissue transfer. The flaps can be customized for specific recipient sites depending on the size of the defect. Fillet flaps can either be pedicle tissue transfers or free-tissue transfers. In cases of pedicle tissue transfers, the defect is measured and templated before being transferred to the portion of the upper extremity that will be converted into the fillet flap. An axial vessel is selected and all attempts are made to preserve maximum vascular inflow and outflow. In cases of total forearm pedicle fillet, an incision is made starting at the lateral border of the ulna and is continued to the level of the interosseous membrane. Digits are amputated, and the flap is swung to cover the defect.<br /><br />Three case studies are presented in this article to illustrate the use of fillet flaps in upper extremity reconstruction. These cases include reconstruction of a destructive shoulder lesion, reconstruction of an extensive forearm injury, and reconstruction of bilateral upper extremity burns. In conclusion, major fillet flaps are a valuable option for reconstructing extensive tissue defects in the upper extremity.

Keywords

soft-tissue defects

upper extremity

major fillet flaps

reconstruction

pedicled flaps

free flaps

injury etiology

harvesting fillet flaps

case studies

tissue defects