The Thoracoepigastric Flap: An Effective Reconstructive Method for Large Upper Extremity Defects in Low- and Middle-income Countries-A Single-center Study.

Background: Injury to the upper limbs, among the most injured anatomical regions of the body, often results in the loss of the skin envelope and the exposure of vital structures, including bone and neurovascular bundles. Reconstructive options in resource-constrained environments are curtailed by both equipment and skilled manpower, necessitating avoidance of resource-intensive techniques. Thoracoepigastric flap (TEF) reconstructions of the forearm, wrist, and hand are simple to perform, provide a sizeable versatile integument cover, and avoid the hygiene and edema complications associated with classic groin flaps in these settings.

Methods: Patients receiving upper extremity reconstruction with TEFs after upper extremity trauma by a single surgeon at our resource-limited tertiary care center were analyzed retrospectively. Patient demographics, mechanism of injury, surgical indication, and postoperative complications were collected.

Results: Between 2011 and 2024, 42 patients, with a mean age of 31 years, underwent TEF reconstruction of upper extremity soft-tissue defects. Most patients in our cohort who had extensive soft tissue loss on an average had 5.3 visits to the operating theater and an average length of stay of 23 days. Defect and flap sizes were not uniformly available from patient charts and were therefore not analyzed. The commonest complication was flap tip necrosis requiring skin grafts in 2 patients.

Conclusions: When raised as double flaps, TEFs are particularly advantageous in low- and middle-income countries because they do not require microsurgical skill, provide extensive coverage for large trauma-related defects, and offer a reliable option for limb reconstruction, especially in settings where follow-up care may be uncertain.