Clinical Applications Of The Medial Arm Flap With The Donor-site Closure Using The Serial Flap Transfer Technique

Objective:To explore the feasibility and technical tips of the reconstruction of donor-site defect of the medial arm flap using a back pedicle flap.Methods:Between December 2015 and June 2019,eleven patients underwent the reconstruction of defects of the head and neck using the pre-expanded medial arm flap,while the donor-site defect was reconstructed using either a latissimus dorsi musculocutaneous flap or a thoracodorsal artery perforator flap.There were nine males and two females with an average age of 12.64 years(range,5～36 years).The etiologies included post-burn scar contracture in 5 cases and congenital melanocytic nevus in the remaining 6 cases.The disease duration ranged from one to 35 years(mean,7.54 years).The size of defects of the head and neck ranged from 10cm×6cm to 15cm×11cm(mean,118.82 ± 32.12cm2).The dimension of the medial arm flap ranged from 18cm×8cm to 27cm×14cm(mean,229.27± 74.65cm2).The size of the dorsal pedicle flaps,including nine latissimus dorsi musculocutaneous flaps and two thoracodorsal artery perforator flaps,ranged from 16cm×7cm to 22cm×10cm(mean,149.64 ± 31.3cm2).All donor sites were primarily closed.Results:All flaps survived after the surgery without any major complications.All wounds at both the recipient sites and donor sites healed primarily.The patients were followed up from one to 18 months(mean,7.64±5.43 months).The color,texture,and thickness of the medial arm flap were similar to that of the recipient site.All patients were satisfied with the outcomes.Conclusion:Either a latissimus dorsi musculocutaneous or a thoracodorsal artery perforator flap could be simultaneously harvested and used to reconstruct the donor-site defect of the medial arm flap when it was used to repair the defects on the head and neck.This strategy could not only ensure an aesthetic reconstruction of the donor site but also provide sufficient tissue for defect reconstruction.