Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND :
Soft tissue war injuries of the upper limb are usually extensive and multiple . Plastic surgeons face
the challenge of reconstructing these injuries in patients who are multiply injured ,and in a time when
facilities for free flap surgery are not available.
OBJECTIVE:
To demonstrate the efficacy of random abdominal flaps in reconstructing soft tissue defects of the
upper limb.
METHODS:
From May 2003 to September 2005, 55 war injury patients with deep soft tissue loss in the upper
limb were managed by random abdominal flaps of different shapes and directions, 13 of them had
other soft tissue injuries affecting other areas in the body. The surgeries were done in busy general
hospitals during war where time, personnel and facilities are limited.
RESULTS:
In 53 patients, the flaps had completely survived without complications, 2 flaps developed partial tip
necrosis and healed later by secondary intention. Donor areas were covered by split thickness skin
grafts in 52 cases, and directly closed in 3 cases. The largest flap dimension was 18 cm length and 15
cm width. The main disadvantages of the flap are donor site scar, bulk of the flap, and the need for a
second stage for flap separation.
CONCLUSION:
Random abdominal flaps are easy, safe, versatile and operative time saving option for coverage of
upper limb injuries. It can be designed in any direction to cover different soft tissue defects. These
flaps still continue to be an excellent alternative for free tissue transfers during war time.