When replantation of traumatic upper arm amputations is contraindicated or not possible, stable soft-tissue coverage preserving proximal stump length and critical joints is required to prevent loss of limb function, aid in prosthetic fitting, and comfort. The purpose of this report is to describe the author’s experience with composite free fillet flaps obtained from the amputated arm segment that utilized flexor muscles adjacent to the vascular pedicle. Eight upper-extremity, composite, free fillet flaps were performed to cover proximal humeral and shoulder defects secondary to upper-arm traumatic amputation over a ten year period. Procedures included 6 composite free fillet flaps and 2 radial forearm free fillet flaps. Four flaps were made sensate by anastomosing either the medial or lateral antebrachial cutaneous nerves to the proximal median nerve stumps. All flaps survived and protective sensation was observed in each neurorrhaphy.
Spare parts or free fillet flaps are well documented and widely used for lower-extremity stump preservation but only recently have been reported for upper-arm traumatic amputations or following radical upper extremity tumor resections. Most previously reported cases for upper extremity coverage have been with fasciocutaneous flap. This is the largest series to date utilizing composite flaps. The composite flap technique may be technically more challenging, however it has the benefit of potentially adding more soft bulk at pressure points to aid in patient comfort and prosthetic fitting. Furthermore, immediate soft-tissue coverage using microvascular transfer of tissue obtained from
amputated limbs remains a viable option that should be considered in the reconstructive upper extremity surgeon’s armamentarium.