Clinical applications of paraumbilical perforator flaps in multiple angiosomes for the reconstruction of the upper limbs

Repair of extensive deep wounds in the forelimb remains challenging for surgeons. The objective of this study was to evaluate the surgical technique and clinical significance of multiple-territory paraumbilical perforator (PUP) flaps in patients with massive soft tissue defects in the upper limbs. Between January 2017 and September 2021, 16 patients (6 women and 10 men) aged 24–54 years (average, 41.4 years) who were hospitalized at the First Affiliated Hospital of Soochow University and the North District of the Suzhou Municipal Hospital were investigated. Their injuries included damage to the fingers, dorsal skin of the hands, wrist, or forearm. Their tendons or bones were exposed after debridement. In some patients, multiple-territory PUP flaps that encompassed adjacent angiosomes were transplanted to cover the soft tissue defects. All flaps survived and healed well. After a follow-up of 2–54 months, all patients recovered satisfactorily in terms of characteristic and functional review. The application of PUP flaps, especially those encompassing multiple angiosomes (multiple-territory PUP flaps), can be an optimal reconstruction method for repairing massive soft tissue defects in the forelimb.