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Case Report

Entire forearm free fillet flap for thoracic reconstruction: Case report.

Carlos Eduardo Torres Fuentes,Lorena Barrera,Carlos Augusto Perez Romero,Diego Fernando Alarcon.


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 4 rib arches and a segmental lobectomy 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 fillet flap technique in the reconstructive plastic surgery field based on the historical concept of spare part.

Key words: amputation; anastomosis, surgical; brachial artery; forearm; humans; thoracic surgery; thoracic wall

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