Random Abdominal Flaps for Reconstruction of Upper Limb War Injuries: A Good Option for a Bad Time

Abstract

ABSTRACT:BACKGROUND :Soft tissue war injuries of the upper limb are usually extensive and multiple . Plastic surgeons facethe challenge of reconstructing these injuries in patients who are multiply injured ,and in a time whenfacilities for free flap surgery are not available.OBJECTIVE:To demonstrate the efficacy of random abdominal flaps in reconstructing soft tissue defects of theupper limb.METHODS:From May 2003 to September 2005, 55 war injury patients with deep soft tissue loss in the upperlimb were managed by random abdominal flaps of different shapes and directions, 13 of them hadother soft tissue injuries affecting other areas in the body. The surgeries were done in busy generalhospitals during war where time, personnel and facilities are limited.RESULTS:In 53 patients, the flaps had completely survived without complications, 2 flaps developed partial tipnecrosis and healed later by secondary intention. Donor areas were covered by split thickness skingrafts in 52 cases, and directly closed in 3 cases. The largest flap dimension was 18 cm length and 15cm width. The main disadvantages of the flap are donor site scar, bulk of the flap, and the need for asecond stage for flap separation.CONCLUSION:Random abdominal flaps are easy, safe, versatile and operative time saving option for coverage ofupper limb injuries. It can be designed in any direction to cover different soft tissue defects. Theseflaps still continue to be an excellent alternative for free tissue transfers during war time.