Complex upper limb reconstruction using dorsoepigastric flap
Complex upper limb injuries include a wide spectrum of lesions commonly encountered in the setting of work-related/ motor vehicle accidents as well as in combat and confrontations, due to the instinctive use of the arms when facing dangerous situations.

This is the case of a twelve year old male patient who suffered a high power fire weapon injury to his left upper arm during a street armed robbery. He presented extensive loss of soft tissues, including part of the proximal third and midshaft of the humerus, part of the biceps muscle, and complete loss of subcutaneous fat and skin over the posterolateral aspect of the arm.

At arrival, the patient was found hemodynamically stable, with a grossly contaminated wound over the aforementioned location, so a formal surgical exploration was indicated.

After broadly explaining the risks and possible outcomes of attempting an extremity saving procedure, the patient and his family decided to accept the operation. During the reconstruction, bilateral peroneal grafts were harvested to reconstruct the damaged bone, and were fixated with a titanium metal plate to the proximal and distal humeral remnants in the upper arm. Also, an ipsilateral dorsoepigastric pediculated flap, with a cutaneous island of 18 x 7 cm was designed and utilized for coverage of the defect

Source: International journal of surgery case reports

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