CASE REPORT

EXTENDED PEDICLE GROIN FLAP RECONSTRUCTION

FOR LARGE FOREARM DEFECT
* Dharmendra Widetya Made, **Agus Roy R H Hamid.
* Resident of General Surgery Department of Surgery Faculty, of Medicine, Udayana University-Sanglah General
Hospital, Denpasar Bali
** Plastic, Reconstructive And Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Udayana
University-Sanglah General Hospital, Denpasar Bali.

The groin flap is a vascularized axial flap based on the superficial circumflex iliac artery. It is used
regularly by many reconstructive surgeons for covering soft tissue defects of the hand.

We reported a male 64th years old patient with The result is, the flap is viable, although there is a
chief complaint wound on his right forearm after little necrotic tissue on the flap. On January 30th
hit by a chain saw. There are an open wound at 2018 the patient undergo operation for harvesting
right forearm 25cm X 15cm in size, with bone and the flap, and debridement necrotomy for the
plate exposed, total rupture of brachioradialis necrotic tissue
muscle, partial rupture of superficial flexor
digitorum muscle, the patient cannot move his
hand and finger

For the defect after necrotomy, we treated

conservatively. After follow up for 1 month the
defect is narrowing
On November 25th 2017, the patient undergo
reconstructive surgery using extended groin flap
and skin graft

Groin flaps have been the most widely used pedicled flaps in hand reconstruction. They can cover
extensive defects of over 10x15cm without sacrificing a major artery or the need for end-to-end
microvascular anastomosis. The groin flap is an axial-patterned cutaneous flap based on the
superficial circumflex iliac arteriovenous system. This flap can provide soft-tissue coverage for defects
on any part of the hand and the distal two thirds of the forearm.
flap can be designed as a bilobed double-leaf (Y) pattern or other shapes to fit specific defects. An
extended groin flap has also been described that includes the lateral femoral cutaneous nerve
(LFCN).
Being an axial pattern flap, the groin flap can reliably be raised with good length-to-breadth ratio.
The donor site scar lies in a cosmetically advantageous position.
Dorsal hand and forearm defects are easily covered by inferiorly based flaps based on the superficial
circumflex and SIEAs. Volar forearm defects are better managed by superiorly based flaps raised on
the paraumbilical perforators
Necrosis of the flap is the worst complication one can have, but fortunately loss of the whole pedicle
flap is very rare

Groin flaps have been the most widely used pedicled flaps in hand reconstruction. The groin flap is an
axial-patterned cutaneous flap based on the superficial circumflex iliac arteriovenous system. Volar
forearm defects are better managed by superiorly based flaps raised on the paraumbilical
perforators
Necrosis of the flap is the worst complication one can have, but fortunately loss of the whole pedicle
flap is very rare

REFFERENCES
1. Amouzou, K. S. et al. (2017) ‘The pedicled groin flap in resurfacing hand burn scar release and other injuries: a five-case series report and review of the literature.’, Annals of burns and fire
disasters, 30(1), pp. 57–61. Available at: http://www.ncbi.nlm.nih.gov/pubmed/28592937%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5446912.
2. Chuang, D. C. C. et al. (1989) ‘Groin flap design and versatility’, Plastic and Reconstructive Surgery, 84(1), pp. 100–107. doi: 10.1097/00006534-198907000-00019.
3. Goertz, O. et al. (2012) ‘The effectiveness of pedicled groin flaps in the treatment of hand defects: Results of 49 patients’, Journal of Hand Surgery. Elsevier Inc., 37(10), pp. 2088–2094. doi:
10.1016/j.jhsa.2012.07.014.
4. Gupta, P. (2017) ‘Groin Flap in Paediatric Age Group to Salvage Hand after Electric Contact Burn: Challenges and Experience’, Journal of Clinical and Diagnostic Research, 11(8), pp. 10–12.
doi: 10.7860/JCDR/2017/29124.10332.
5. Jokuszies, A. et al. (2010) ‘Der gestielte Leistenlappen zur Defektdeckung an der Hand’, Operative Orthopadie und Traumatologie, 22(4), pp. 440–451. doi: 10.1007/s00064-010-9017-6.