INFERIORLY BASED ABDOMEN FLAP
As the name suggests it is taken from the abdomen skin.most commonly used are the superior and inferior based flaps.
Both the superior and inferior based flaps are taken either as axial pattern based on a particular vessel or as a random pattern
USual allowed ration for the random pattern flap is 1:1.but one can take accordingly when based on a axial pattern vessel.
Defect in the hand is measured and lint pattern is taken. Make sure adequate base is marked so that the flap is well perfumed.
Lie of the flap is assessed with the hand in the abdomen. Temporary markings are made over the abdomen, now the lint kept over the abdomen and then flap is checked in position with the defect of the hand which is to be covered.
FLAP ELEVATION AND INSET
Distal most end of the flap is now incised and then flap is raised upto the level of scarpas fascia,as the flap is raised make sure that the edges are kept in position by skin hook, complete the incision all around.
Check for perfusion of the flap. Wrap it with wet saline pad. Donor site raw area reduction is done with absorbable stitches.
Donor site closed with SSG harvested from thigh site.
Flap inset given with ethilon over the raw area oF the hand.
Dressing is done with the hand in right position. Elbow is supported with the pillow.
Every day the flap is cleaned and adequate padding is done.day 5 ssg staplers or sutures are removed.day 10 sutures are removed from the flap and adviced daily bath now till day 21,when flap is diveded and insert is given on other business end of the raw area of the hand.
Further flap might need a small procedure of flap thinning and trimming as and when required.