Pedicled abdominal flap using deep inferior epigastric artery perforators for forearm reconstruction: A case report

Figure 1 Initial clinical photographs and plain radiographs of the right forearm. A and B: The 15 cm × 10 cm soft tissue defect of the forearm and open fracture with bone defect of distal ulnar bone were found; C and D: Initially, the ulnar nerve, artery, and tendons were reconstructed, and internal fixation with bone cement were done using the Masquelet technique.

Figure 2 Clinical photographs of the right forearm 10 d after orthopedic management. A-C: Surgical debridement and negative-pressure wound therapy were performed to prepare the wound bed. Final debridement revealed a 20 cm × 15 cm soft tissue defect with flexor and extensor tendons exposure.

Figure 3 Identification of the deep inferior epigastric artery perforators. A and B: Preoperative computed tomography findings using 1 mm of slice thickness gave appropriate localization to two deep inferior epigastric artery perforators; C: Intraoperatively, perforators are detected in the paraumbilical area with a handheld Doppler probe, and their positions (X) are marked on the skin.

Figure 4 Postoperative clinical photographs and plain radiographs of the right forearm. A-D: After 6 mo, the pedicled DIEP flap and abdominal donor site were stable without complications; E and F: Ten weeks after the first stage of Masquelet technique, the second stage was performed. Six months later, bone union was achieved.