Reconstruction of complex upper limb wounds can be achieved with staged skin substitute, pedicled flaps and/or free tissue transfer. Each option has its own distinct advantage and disadvantage profiles for cases where all of these options are viable. Our senior author prefers free tissue transfer. We would like to investigate the clinical and patient reported outcomes in all reconstructive upper limb cases managed by our senior author at Waikato Hospital.
Retrospective review of senior author's electronic logbook of patients who have had upper limb injury or oncological pathology requiring upper limb reconstruction at Waikato Hospital from June 2020-July 2022 (cross referenced with hospital theatre records). Any patient who had a wound defect of 10X10 cm or greater was included in the study.These patients were contacted to complete several quality of life questionnaires and a standardised proforma was used for data collection.
10 patients and 11 procedures were included in the study. 6 patients had free tissue transfers (7 procedures), 3 with pedicled flaps and 1 with skin substitute. Mean age is 54 years and all are males. Mean wound defects in all three groups are 202cm2, 89cm2 and 168cm2 respectively (Fisher test p=0.02). The largest wound defect was 654cm2 requiring a chimeric anterolateral thigh flap with vastus lateralis. Flap success rate is 100% with 18% revision rate. One out of three chest flaps failed, as patient avulsed flap from wound. Mean POSAS scar score is 19 for free flap group, 52 for pedicled flap group and 31 for skin substitute group (chi-squared p>0.05). Mean duration of hospital stay was 6.4 days (free flap), 14 days (pedicled flap), 9 days (skin substitute).
Our cohort reported high satisfaction and good functional outcomes after free flap surgery, but this does not reach statistical significance when compared with other options.