Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2024; 12(4): 828-834
Published online Feb 6, 2024. doi: 10.12998/wjcc.v12.i4.828
Pedicled abdominal flap using deep inferior epigastric artery perforators for forearm reconstruction: A case report
Jae Hyung Jeon, Kyung Wook Kim, Hong Bae Jeon
Jae Hyung Jeon, Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan 31116, Chungnam, South Korea
Kyung Wook Kim, Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea
Hong Bae Jeon, Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea
Co-first authors: Jae Hyung Jeon and Kyung Wook Kim.
Author contributions: Jeon JH and Kim KW contributed equally; Jeon JH and Kim KW were performed literature search and data collection, and wrote the manuscript; Jeon HB supervised the whole process of the study and makes critical revisions related to important intellectual content of the manuscript; all authors read and approved the final manuscript.
Supported by The Bio&Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT), No. RS-2023-00220408.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong Bae Jeon, MD, Assistant Professor, Doctor, Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Chungnam, South Korea. jeonhb110@dankook.ac.kr
Received: October 16, 2023
Peer-review started: October 16, 2023
First decision: December 5, 2023
Revised: December 22, 2023
Accepted: January 15, 2024
Article in press: January 15, 2024
Published online: February 6, 2024
Processing time: 101 Days and 4.1 Hours
Abstract
BACKGROUND

Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects. However, some drawbacks include restricted flap size, partial flap loss, and donor-site morbidity. To address these concerns, we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators (DIEP) for forearm reconstruction in a patient with a large soft tissue defect.

CASE SUMMARY

A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine. A 15 cm × 10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found. One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique, the patient was referred to the plastic and reconstructive surgery department for wound coverage. Surgical debridement and negative-pressure wound therapy revealed a 20 cm × 15 cm soft tissue defect. A pedicle abdominal flap with the DIEP was used to cover the defect. Three weeks later, the flap was detached from the abdomen, and the abdominal defect was directly closed. Subsequently, the second stage of Masquelet technique was performed at the fracture site at week 10. Finally, all donor and recipient sites healed without complications, such as flap dehiscence, infection, hematoma, or necrosis. Fracture site osteosynthesis was achieved without complications.

CONCLUSION

Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.

Keywords: Forearm injury; Open fracture reduction; Perforator flap; Deep inferior epigastric artery perforators; Case report

Core Tip: Compared to traditional pedicled groin and abdominal flaps for forearm reconstruction, pedicled abdominal flap with the deep inferior epigastric artery perforators offer a more robust blood supply and larger soft tissue, reducing the risk of flap necrosis. In addition, it eliminates the need for anastomoses, reduces operative time, and allows direct closure of the donor site aesthetically without skin grafts. Using computed tomography angiography and handheld Doppler can help surgeons find appropriate perforators vessels during surgery. This report provides a suitable option for managing complex upper extremity injuries and providing adequate soft tissue coverage with minimal donor-site morbidity.