A Bilobed Pedicled Groin Flap for Reconstruction of Forearm Skin Defects following Replantation

Abstract

The versatility of a pedicled groin flap can be further increased by raising it in a bilobed fashion. This allows the flap to cover both the volar and dorsal surfaces of a hand or forearm defect. A 48-year-old man sustained an avulsion amputation of his right forearm by a rolling machine in a workplace accident. Replantation of the right forearm was performed, and the postoperative course was uneventful. Unfortunately, the wound healing was complicated by circumferential marginal skin necrosis, which was confined to the distal forearm. A bilobed pedicled groin flap was performed for the wound coverage because reconstruction with a free flap would be very risky as the vessels were avulsed from the proximal part of the forearm. A good functional recovery of the hand and fingers was noted at 12 months' follow-up. The advantages of a bilobed pedicle groin flap are that it allows coverage of both the volar and dorsal surfaces at one setting and primary closure of the donor site is possible. Furthermore, a long tube-shaped pedicle in this flap can reduce the patient discomfort and prevent finger stiffness by allowing a range of motion exercise. In conclusion, the bilobed pedicled groin flap is a useful option to cover soft tissue defects involving both the volar and dorsal surfaces over the mid- to distal forearm, especially when the free flap is contraindicated.

Fig. 1.

Circumferential marginal skin necrosis developed and progressed gradually over the distal right forearm after a successful replantation. Underlying ulna bone, flexor and extensor tendons were exposed after debridement and removal of necrotic skin.

Fig. 2.

The forearm was approximated to the ipsilateral groin where the flap was inset onto both the volar and dorsal defects of the forearm. The wound over the dorsoulnar aspect of the mid-forearm was covered with a split thickness skin graft.