Contralateral lumbo-umbilical flap: A versatile technique for volar finger coverage

Abstract

Background: While contemplating any difficult soft tissue reconstruction, patient comfort and compliance is of paramount importance. Reconstruction of the volar aspect of fingers and hand by the ipsilateral pedicled flaps (groin flap, abdominal flaps) is demanding as the flap inset is difficult for the surgeon and very uncomfortable for the patient. This often leads to flap complications. For the comfort of the patient, better compliance and ease of complete inset, we planned to manage soft tissue defects of the volar aspect of fingers and hand by a new contralateral pedicled lumbo-umbilical flap. This flap is based on the paraumbilical perforators of deep inferior epigastric artery.

Materials and methods: The contralateral pedicled lumbo-umbilical flap was used in eight patients with high-tension electrical burn injuries involving the volar aspect of fingers and hand. The patients were closely observed for first 6 weeks for any flap or donor site complications and then followed monthly to assess donor and recipient site characteristics for 6 months to 2 years.

Results and conclusion: Large flaps up to 8 cm × 16 cm were raised. All but one flaps survived completely. All patients were mobilised within 48 h and five were discharged in less than a week after initial inset. The flap is reliable, easy to harvest and easy to inset on the volar aspect of fingers. The arm is positioned in a very comfortable position. The main disadvantage, however, is a conspicuous abdominal scar.

Keywords: Finger defect; groin flap; hand defect; high-tension electric burn; lumbo-umbilical flap; paraumbilical perforators.

Figure 1

Lumbo-umbilical flap direction and extension limit shown up to posterior axillary line

Figure 2

(a) Severe electrical burn injury right hand. (b) Tissue loss over index, middle and ring fingers with exposed tendon/bone after debridement. (c) A 8 cm × 16 cm contralateral lumbo-umbilical perforator pedicled flap was planned for cover. (d) Volar defect of fingers was covered with contralateral lumbo-umbilical perforator pedicled flap in a comfortable position. (e) Well-settled flap after 2 months with conspicuous abdominal scar

Figure 3

(a) Deep electric burn right middle and ring finger. (b) A 7 cm × 15 cm contralateral lumbo-umbilical perforator pedicled flap was planned for cover. (c) Showing post-operative picture after detachment and inset of flap. (d) Results, hand and abdominal scar after 18 months. (e) Post-flap thinning on fingers

Figure 4

(a) Severe electrical burn injury left hand. (b) Showing soft tissue loss over thumb, index and middle finger with exposed tendon of middle finger. (c) The result after 12 months

Figure 5

Comfortable position of upper limb when contralateral lumbo-umbilical abdominal flap is used