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The use of pedicled abdominal flap to salvage a necrotic forearm - a case study


International Physical Medicine & Rehabilitation Journal
Kwesi O Nsaful,1 C Tetteyfio- Koney,2 EO Apraku-Brako,1 T Mahama-Toure,1  AA Avoka,1 A Antwi- Afriyie,2 HN Atampugre1

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Abstract

Background: Pedicled abdominal and groin flaps have since the 70s and80s continued to provide reliable solutions for upper limb injuries that require flap cover. In recent times reconstructive surgeons have found the use of free flaps a better alternative. However, in centres where microsurgery facilities are not available or where the patient cannot afford such services, the pedicle flaps continue to have an important role. Interestingly, some literature states that the long term outcomes of successful pedicled flaps are equal or even better than free flaps. Abdominal flaps together with the groin flaps continue to be the workhorse flaps in the developing world as well as at our centre for major hand injuries with tissue loss.

Aim: The aim of this work is to point out the reliability of the abdominal flap leading to a good clinical outcome.

Case presentation: This is a case report of an 8-year-old boy, who sustained a closed fracture to the left forearm. He was taken to a traditional bone setter who wrapped the arm up with herbs. However, after about 2 weeks it was noticed the arm had deteriorated significantly. He presented to our centre 3 weeks after the injury., On arrival at the 37 Military Hospital, it was noticed that the bones of the forearm were exposed, with extensive ulceration and necrotizing of tissue of the lateral extensor and whole flexor surfaces of the left forearm. The wound was generally septic. The wound was debrided and an Abdominal flap cover was done to salvage his upper limb.

Conclusion: The abdominal flap provides a reliable option for reconstruction and salvage of the upper limb with good colour and texture match. Together with the Groin Flaps, Abdominal Flaps continue to be dependable additions in the quiver of the reconstructive surgeon in the developing world.

Keywords

abdominal flaps, groin flaps, fascio cutaneous flaps, traditional bone setters

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