Entire forearm free fillet flap for thoracic reconstruction: Case report

Abstract

A 71-year-old patient diagnosed with recurrence of leiomyosarcoma in the left axillary region, which involved the infraspinatus muscle, subscapularis muscle, teres minor muscle, trapezius muscle, the posterior and lateral walls of the left hemithorax, rib arches and lung. Extended thoracic inter-scapular amputation of the left upper limb was performed, along with the resection of the 3rd, 4th, 5th and 6th rib arches and a segmental lobectomy of the lingular by the orthopedic and thoracic surgery teams. In order to reconstruct this large defect without adding morbidity from a donor area, it was decided to design a large free composite flap from the entire forearm skin of the amputated limb, based on the brachial artery and superficial venous system; the anastomosis was performed to the subclavian vessels. This procedure allowed satisfactory coverage of the mesh and the osteosynthesis material used to reconstruct the chest wall. The aim of the report is to demonstrate the utility of the fillet flap technique in the reconstructive plastic surgery field based on the historical concept of spare parts.