Role of Lateral Thoracic Flap for Reconstruction of Defects of Upper Limb (Peri Elbow Region)

Reconstruction of defects around elbow and upper arm is a challenging task for reconstructive plastic surgeon. Local tissues will not be adequate to cover the large defect. The lateral thoracic artery flap provides good skin cover for the defects of elbow and upper arm. The objective is to study the feasibility and therapeutic effect of lateral thoracic flaps for the defects of upper extremities (around elbow) This is a clinical, prospective study conducted between 2012 and 2014 at Osmania General Hospital / Osmania Medical College, Hyderabad. Ten cases with soft tissue defects in the upper extremities exposing bone were included in the study and re-constructed with lateral thoracic artery flap. In this study there were 250 patients with Upper limb defects with either trauma or burns as the causative factor admitted to the department of Plastic Surgery. Ten Peri-Elbow defects selected for this study constituted 4 % of Upper limb defects admitted to Plastic Surgery department. The mode of injury is due to electrical injuries in 8 cases (80%) and 2nd common cause is road traffic accidents in 2 cases (20%). All patients are male (100%) and belong to young and middle age group ranging from 8 years to 48 years. The most common site of defect is upper arm seen in four cases (40%) upper arm & elbow in 3 cases (30%) and elbow in 3 cases (30%). The lateral thoracic flap was used to reconstruct the defects of upper arm (upper, middle, lower third) involving antero-medial aspect in five cases and postero-lateral aspect in four cases & 3/4th circumference in one case. Anteriorly based lateral thoracic flap used in four cases and posteriorly based in four cases. Lateral thoraco epigastric flap used to reconstruct the elbow defects in two cases.The wounds healed well in all cases, except in one case which is used to cover the defect on the elbow developed partial necrosis which was debrided and covered with skin grafting. The lateral thoracic flap is a flexible alternative with good therapeutic results for covering the defects in the upper extremities, with a reliable blood supply, without any donor site morbidity.