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The Split Pedicle Groin Flap: New Refinement in Groin Flap Application and Technique for Combined Thumb and Dorsal Hand Defects

Saint-Cyr, Michel M.D.; Wong, Corrine M.R.C.S.

doi: 10.1097/PRS.0b013e31823af1e5

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

Correspondence to Dr. Saint-Cyr, Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75290-9132

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The pedicle groin flap has played a longstanding and useful role in reconstructive surgery of the hand. This flap is especially useful for coverage of dorsal hand injuries and is a highly reliable way of resurfacing soft-tissue defects of the hand. Based on the superficial circumflex iliac artery, the vascularity of the pedicle groin flap is axial-based and can be considered axial up to the midaxillary line.1 Vascularity distal or lateral to this point can be considered random. It has been described and used clinically in multiple fashions, such as a pedicle groin flap,25 free groin flap,68 and free perforator groin flap.9 An extensive literature search revealed that there is very limited published work10 on the use of a split pedicle groin flap. This additional case illustrates the usefulness of this flap for coverage of more than one soft-tissue defect. When faced with combined dorsal hand or dorsal digital defects, the pedicle groin flap can be split longitudinally along the axis of its vascularity to provide simultaneous coverage of two recipient sites or more.

We report a case where a 32-year-old patient suffered a dorsal hand and thumb degloving injury in a motor vehicle accident along with multiple other injuries, including bilateral femur fractures, a humerus fracture, and head trauma. He was not a candidate for a free tissue transfer. He had exposure of the extensor pollicis longus tendon and extensor indicis complex (Fig. 1). Therefore, an ipsilateral pedicle groin flap was designed to provide coverage of the dorsum of his hand and dorsal thumb (Fig. 2). The patient underwent radical débridement of all of his wounds, and an 8 × 24-cm pedicled groin flap was harvested. The proximal portion of the groin flap was split to provide additional flap coverage to the dorsum of the thumb, and this was inset appropriately based on the recipient-site defect (Figs. 2 and 3). Postoperatively, both flaps were divided after 4 weeks and defatted before being reinset. The patient did not undergo any marginal necrosis of his flap and went on to appropriate soft-tissue healing of his wound.

The split pedicle groin flap is a further refinement in the utility of the pedicle groin flap for dorsal hand defects. The splitting of the flap should be performed along the longitudinal axis of the flap, along the same axis as the superficial circumflex iliac artery and vein. Multiple axial branches from the main pedicle are distributed throughout the flap, and the flap can be safely split longitudinally to provide coverage of adjacent defects.

Michel Saint-Cyr, M.D.

Corrine Wong, M.R.C.S.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

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1. McGregor IA, Jackson IT. The groin flap. Br J Plast Surg. 1972;25:3–16.
2. Arner M, Möller K. Morbidity of the pedicled groin flap: A retrospective study of 44 cases. Scand J Plast Reconstr Surg Hand Surg. 1994;28:143–146.
3. Buchman SJ, Eglseder WA Jr, Robertson BC. Pedicled groin flaps for upper-extremity reconstruction in the elderly: A report of 4 cases. Arch Phys Med Rehabil. 2002;83:850–854.
4. Chuang DC, Colony LH, Chen HC, Wei FC. Groin flap design and versatility. Plast Reconstr Surg. 1989;84:100–107.
5. Li YY, Wang JL, Lu Y, Huang J. Resurfacing deep wound of upper extremities with pedicled groin flaps. Burns 2000;26:283–288.
6. Chuang DC, Jeng SF, Chen HT, Chen HC, Wei FC. Experience of 73 free groin flaps. Br J Plast Surg. 1992;45:81–85.
7. Daniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses: A clinical technique. Plast Reconstr Surg. 1973;52:111–117.
8. Hough M, Fenn C, Kay SP. The use of free groin flaps in children. Plast Reconstr Surg. 2004;113:1161–1166.
9. Hsu WM, Chao WN, Yang C, et al.. Evolution of the free groin flap: The superficial circumflex iliac artery perforator flap. Plast Reconstr Surg. 2007;119:1491–1498.
10. Rasheed T, Hill C, Riaz M. Innovations in flap design: Modified groin flap for closure of multiple finger defects. Burns 2000;26:186–189.
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