Hybrid-Enveloped Pedicle of Distant Abdominal Flap for Reconstruction of Extensive Upper Extremity Defects

BACKGROUND: Extensive upper extremity soft-tissue defects with exposed vital structures present a significant reconstructive challenge, particularly when microsurgical options are unavailable. Traditional distant pedicled abdominal flaps require a wide skin tube to protect the vascular pedicle, resulting in substantial donor-site morbidity and risks of pedicle compression. This study introduces a modified technique utilizing a hybrid combination of artificial dermis and local skin flap to create a hybrid-enveloped pedicle, aiming to minimize donor-site sacrifice and improve postoperative management. METHODS: Between 2019 and 2025, 5 patients with extensive proximal or mid-forearm defects underwent reconstruction using a paraumbilical perforator-based pedicled abdominal flap. The vascular pedicle was protected using a conduit constructed from a combination of a small skin flap and artificial dermis, forming a flexible tube. A retrospective review assessed flap survival, complications, donor-site outcomes, and functional recovery. RESULTS: All 5 flaps survived. The length of the pedicle segment enclosed by the hybrid envelope ranged from 4 to 7 cm. No pedicle compression, infection, or vascular crisis occurred. One patient developed distal flap-tip necrosis, which healed with conservative management. All flaps demonstrated satisfactory contour, texture, and integration with surrounding tissues. Upper-extremity joint motion recovered well in all cases, and all patients reported high satisfaction with the reconstructive outcome. CONCLUSIONS: The artificial dermis-assisted hybrid pedicle technique offers a safe, reliable, and tissue-sparing alternative to the conventional skin-tube method for distant abdominal flap transfer. It effectively reduces donor-site morbidity, minimizes compression risk, enhances postoperative monitoring, and facilitates earlier rehabilitation. This refined approach represents a practical and accessible reconstructive solution for complex upper extremity defects in settings where free tissue transfer is contraindicated or unavailable.