Monday, April 6, 2020

Forked Flap - Shoulder joint Defect

Forked Flap - Shoulder joint Defect


Defects of shoulder joint

Always shoulder joint defects are difficult to manage and are rare defects in plastic surgery. Usually, it can be covered with a small flap based on the supraclavicular artery at the clavicle level, when its a large defect other musculocutaneous or fasciocutaneous flap might be required.


Causes and approach


Very common defects of the shoulder joint is the burns, implant exposed ( as in this case), RTA abrasion injury, post abscess drainage. Since this is an anti dependent area once has to make the wound a chronic one before covering the raw area. early u do a flap infection rate increases, flap failure is at the highest rate.



Our Case Approach  

This patient a diabetic patient with an avulsion injury of the shoulder joint with implant exposed after fixation of the shoulder joint and humerus fixation was done. Initial suturing primarily was done and the skin necrosis occurred. So patient was put on VAC Therapy and then planned for a flap cover.


Shoulder Joint Defect with Implant Exposed

As shown in the above image Two fasciocutaneous flaps Based on supraclavicular artery have been raised and raw area reduction done and flowing which insert was given with bolster stitches with absorbable sutures and flap together with non-absorbable stitches.


 Forked Flap - Post Operative Follow up

This picture shows the post-operative follow up with nicely settled flap after suture removal. Follow up the patient with mobilization and scar massage and compression dressings.












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