Rotational Pedicle Myocutaneous Forearm Fillet Flap Used to Fill Forequarter Amputation Defect: Indications and Uses

A full-thickness fourth-degree burn to a large area of the upper extremity may require a forequarter amputation. Whereas our case describes a burn injury, forequarter amputations may more commonly be done in oncological surgery. In addition to the challenge of providing well-vascularized tissue coverage, the burn patient may also pose the complication of respiratory compromise in a systemically ill person. Fillet flaps have often been utilized as “spare part” reconstruction. Although previous forequarter amputations have been covered with free myocutanous forearm fillet flaps, we devised a rotational pedicle myocutaneous forearm fillet flap that might be less complex than a microvascular reconstruction. This article describes the technique and advantages of the pedicle fillet flap of the upper limb. This technique eliminates the risks of delayed warm ischemia time and avoids additional morbidity of donor sites. Although we sought to find a simpler, more rapid procedure for a burn patient, the pedicle forearm fillet flap has applications for both burn and oncological forequarter amputation defects. It provides a good combination of large tissue coverage with maximum perfusion of muscle bulk. The pedicle flap also enabled us to keep the distal part vascularized and to “bank” it for later use when the recipient area was well vascularized and free of infection.