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BACKGROUND: Free flap reconstruction has become the more common treatment over pedicled groin flaps for reconstruction of upper extremity injuries in recent years. Groin flaps are still used for a variety of reasons, though limited literature is available to guide surgeons and patients regarding outcomes. This study aimed to investigate the epidemiology and outcomes of pedicled groin flaps for upper extremity pathology. METHODS: The study was a single-institution retrospective case series at a level one trauma center including patients who underwent pedicled groin flaps for upper extremity soft tissue coverage between 1992 and 2022. The data collected included patient and injury characteristics, surgical management, and complication data. Ordinal logistic regression, univariate analysis, and bivariate analysis were performed to assess the relationship between the total number of groin flap surgeries and complications with patient and injury characteristics. RESULTS: The analysis included 88 pedicled groin flaps performed for upper extremity injuries, with a median follow-up of 1.14 years after injury. Patients had a median age of 35 (interquartile range [IQR]: 22-49) years and underwent a median of 4 (IQR: 3-5.25) surgeries with stiffness (90.6%), partial flap loss (38%), and infection (32%) as the most common complications. High-energy injuries increased the risk of requiring more surgeries based on ordinal logistic regression. Univariate and bivariate analysis revealed no significant difference in wound complications based on patient or injury characteristics. CONCLUSIONS: Patients undergoing pedicled groin flaps for upper extremity injuries can expect to undergo an average of 4 surgeries, and high-energy injuries predict the need for more surgeries.

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BACKGROUND: Pedicled groin flap is a reliable reconstructive method for digits. However, problems with the contour, mobility, and sensation, especially while providing strict thin skin coverage still exist. PATIENTS AND METHODS: A total of 17 cases with 36 digits injured by trauma were identified. One-stage secondary debulking procedure was adopted for flap revision. The skin over the flap was harvested as a full-thickness graft. At the dorsal side of the reconstructed digit, the subcutaneous tissue and fat were debulked till the deep fascial layer. At the volar side, the flap was debulked till the superficial fascial layer. The skin was then re-grafted. The outcomes were reviewed after 12 months follow-up. RESULTS: The average timing for debulking procedure after flap reconstruction was 116 days. After removal of bolster dressing 7 days after debulking, all the grafted skin took well. A mean length of 2.5 cm of digit was preserved for the non-replantable digits. The reconstructed digits achieved comparable diameter and contour with that of the contralateral side. The two-point discrimination of the injured digits of adults was 10.4 ± 1.6 mm. Using a 5-point Likert scale, post-debulking digits showed statistically significant improvement compared to pre-debulking digits. The evaluation of the patients' satisfactory outcomes of the reconstructed digits was judged as "very satisfying" in 12 patients (75 %) and "good" in 4 patients (25 %). CONCLUSIONS: One-stage secondary debulking procedure resulted in excellent functional and esthetic outcomes for digits according to different structures of the dorsal and volar sides. LEVEL OF EVIDENCE: IV, Retrospective.

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The acute management of deep burns to the dorsum of the hand and fingers represents a challenge for the reconstructive surgeon. The exposure of osteo-tendinous structures often requires flap coverage, in a context where loco-regional or free flaps are not always feasible. The aims of reconstruction are to preserve a maximum of digital length, provide supple tissue, obtain protective sensitivity, and achieve a functional hand at 1 year. We report here on a series of 8 deep burns to the dorsum of the hand. Six hands were covered by Colson abdominal flap-graft and two by pedicled inguinal flap. Four out of 6 patients were reviewed in consultation, 1 patient was lost to follow-up, and 1 patient died. Clinical evaluation was performed by a surgeon other than the operator. Functional results are highly variable. Coverage time varies according to lesion depth and patient severity. Flap weaning took place at an average of 30 days. DASH scores ranged from 17.5 to 93/100, with average to poor total active motion (TAM) scores. The aesthetic result was satisfactory, with a Vancouver score of 4.5/13 on average, and an overall patient opinion of 3.75/10 on the POSAS scale. For deep burns to the dorsum of the hand and fingers, local flaps are rarely possible, and loco-regional flaps are not feasible in cases of associated upper limb damage. For medium to large surface areas, pedicled inguinal flaps and pocketing are two reliable techniques. Nevertheless, they require relative immobilization of the upper limb, which leads to stiffness. The question of digital pinning in the intrinsic or straight position remains unresolved, and does not appear to prevent secondary deformities. There is also a learning curve for these two flaps, even though they are reputed to be easy to lift. McGregor's flap or pocketing can be weighed against free flaps. However, the operating time is long, the surgical technique is complex, and vascular damage is common in the burn patient population. Although there have been enormous technical advances since their descriptions, the pedicled inguinal flap and pocketing remain alternatives to be considered in the acute management of deep burns to the dorsum of the hand. In this presentation, we propose a surgical management algorithm to situate these two techniques in the plastic surgeon's therapeutic armament.

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Most of the articles on the groin flap were published in the period from 1975 to 2010, from 2015 to 2022, the SCIP flap surpassed the groin flap in the number of publications. According to the results of a literature search in PubMed and RINC, 30 articles were found and selected, including 288 flaps from the iliac region. The length of the vascular pedicle, the diameter of the vessels, the complications, the prevalence of the flap in the reconstruction of the head and neck, the thickness and the size of the flap were evaluated. Both of these flaps have the same nutrition, but different levels of dissection. In comparison with the groin flap, the SCIP flap has a longer vascular pedicle, which can be enlarged due to new techniques, which also allows it to be used as an ultra-thin flap, and it reduces the need for secondary procedures for defatting and reduces the risks of the complications in the donor area. The thickness of the SCIP flap is less than the groin one, which, according to the author, increases the aesthetic level of operations in the facial area in the case of the texture and color of the flap. Vascular anatomy of the SCIP flap is variable, therefore, the use of preoperative planning is necessary. Despite this, complications in the donor or recipient area during reconstruction with a SCIP flap are minimal. It has been proved that the SCIP flap is versatile and safe in all aspects of reconstruction. It can be concluded that the SCIP flap should be considered as a «workhorse¼ in reconstructive microsurgery of soft tissues of the throat and oral cavity.

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INTRODUCTION AND IMPORTANCE: Degloving injuries of the hand or fingers have a devastating presentation which challenges a surgeon to conduct reconstruction in order to resurface the naked finger and recover its function. The gold standard treatment for degloving injuries is using skin grafting and flap. The pedicle of groin flap is based on superficial circumflex iliac artery. It is one of standard flaps used in reconstruction of degloving fingers. In this study, we use groin flap for reconstruction of traumatic total degloving little finger. PRESENTATION OF CASE: This is a case of 34-years old man with total degloving of his left little finger because stuck inside running cutting machine in a clothes factory. The patient was then brought to the Hasan Sadikin General Hospital. The patient underwent thorough debridement, preparation of the donor site, and groin flap. After a week, the wound was in good condition with no signs of infection. CLINICAL DISCUSSION: The groin or skin flap is pedicled and vascularized by superficial circumflex artery. It can be considered as an option for treatment of single finger degloving wound because of its compliant nature and vascularization reliability. Despite this, it often results in bulky appearance which needs to be reconstructed later. THE CONCLUSION: Groin flaps are an appropriate method in managing degloving little fingers and are still cosmetically acceptable.

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Degloving is a type of avulsion injury that leads to the separation of the skin from its underlying tissues. It is usually caused by industrial machinery through smashing or traction mechanisms, where the patient typically tries to avoid severe trauma by pulling their hand off, resulting in this particular injury. Although free flaps have now become the standard of treatment in many institutions, the lack of this possibility makes pedicled flaps a good reconstructive option, with advantages such as low donor-site morbidity, low procedure costs, and relatively easy dissection of the flap. Since the description of the pedicled groin flap technique by McGregor and Jackson, this reconstructive option has become a versatile flap for the coverage of wounds on the hand and distal forearm. This axial-patterned cutaneous flap is based on the superficial circumflex arteriovenous system, which can provide soft-tissue coverage for moderate-to-severe injuries, especially those caused by work accidents. This article aims to describe our experience in treating five different cases of traumatic degloving hand injuries using a groin flap for coverage, with excellent aesthetic and functional results. Two of these cases resulted from degloving after a traction accident, one from a firework explosion, one from a gunshot, and finally, one as a result of an electric wound.

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BACKGROUND: Groin flaps have been used as pedicled and free flaps by plastic surgeons for time immemorial. The superficial circumflex iliac artery perforator (SCIP) flap has evolved from the groin flap in which the entire skin territory of the groin flap can be harvested based on the perforators of the superficial circumflex iliac artery (SCIA) and only a part of the SCIA can be taken along with. The pedicled SCIP flap can also be utilized in a large number of cases which is described in our article. PATIENTS AND METHODS: Between January 2022 to July 2022, 15 patients were operated on using the pedicled SCIP flap. Twelve patients were males and 3 patients were females. Nine patients presented with a defect in the hand/forearm, 2 patients had a defect in the scrotum, 2 patients had a defect in the penis, 1 patient had a defect in the inguinal region overlying the femoral vessels and 1 patient had a defect in the lower abdomen. RESULTS: There was a partial loss of one flap and a complete loss of one flap from pedicle compression. The donor site healed well in all cases with no evidence of wound disruption or seroma or hematoma formation. As all the flaps were quite thin, no debulking was needed as an additional procedure. CONCLUSION: The dependability of the pedicled SCIP flap implies that this flap should be used more often in reconstructions in and around the genital area and also in cases of upper limb coverage instead of the classical groin flap.

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OBJECTIVE: The differences in speech function between groin flap reconstruction and anterolateral thigh (ALT) flap reconstruction after hemiglossectomy have not been clarified to date. This study aimed to compare Japanese speech intelligibility after hemiglossectomy reconstruction using groin and ALT flaps of similar thickness. METHODS: Data of patients who underwent hemiglossectomy reconstruction with groin or ALT flaps between April 2010 and March 2020 were collected from the medical chart database. The ALT flap was the first choice for hemiglossectomy reconstruction, and a groin flap was used when the ALT flap was >10 mm. Cases in which speech intelligibility assessments based on Hirose's 10-point scoring system, the TKR speech test, and the Japanese speech intelligibility test for 100 monosyllables were performed after 6 months postoperatively were extracted. The per-patient scores for each assessment were initially compared between the two flap groups. Then, the results of the Japanese speech intelligibility test for 100 monosyllables were reanalyzed on a syllable-by-syllable basis. RESULTS: Among the 44 hemiglossectomy patients who underwent free-flap reconstruction during the study period, 14 (seven each in the groin flap and ALT flap groups) underwent all three conventional speech intelligibility assessments after 6 months postoperatively. The two groups showed no significant difference in postoperative speech intelligibility in any of the three patient assessment methods. However, in intergroup comparisons based on per-syllable accuracy for each of the 100 monosyllables, the groin flap group showed 19 syllables with a significantly higher accuracy, whereas the ALT flap group showed one such syllable. In particular, five out of the six alveolar consonants (/t/ and /d/) were more accurately articulated in the groin flap group. Per-syllable accuracy was significantly higher in the groin flap group (74.6% vs. 66.7%; 95% confidence interval: 4.6-11.1, p < 0.001). CONCLUSION: In patients undergoing hemiglossectomy reconstruction, our new analysis method, which compared intelligibility by syllables, showed that the groin flap yielded higher speech intelligibility than the ALT flap. This difference was evident at all four articulation points involving the tongue, whereas there was no significant difference at the two articulation points without tongue involvement.

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Open de-gloving hand injuries with exposed tendons and bones require coverage by a flap. Conventionally used groin or abdominal flaps are cumbersome to patients due to extensive dressing and prolonged passive positioning of the hand until pedicle division. Superficial circumflex iliac artery (SCIA) flap is evolved from a traditional groin flap, and because of its thinness, pliability, and concealed donor site, it is an ideal option for single-stage reconstruction of traumatic hand defects avoiding discomforting passive hand position, joint stiffness, and unexpected flap avulsion which were associated with traditional groin flap. All patients with exposed bones or tendons due to traumatic hand injuries who opted for free flap coverage during the year 2018 to 2020 were enrolled in our study. After initial debridement, the wound was covered with a free SCIA flap. Duration of hospital stay, days out of work, the number of dressings required, postoperative complications, and any secondary procedures for flap readjustment were noted till six months postoperatively. A total of eight patients were included in the study. The mechanism of injury was road traffic accidents in a single patient and occupational injury in eight patients. The average duration of hospital stay was six days after reconstructive surgery. The average number of dressings a patient had was 18, and only two patients required flap thinning. Only one patient had a postoperative infection which was managed with dressings and antibiotics. One patient had peripheral flap necrosis. We had zero flap re-exploration. Therefore, we conclude that hand defects coverage with SCIA flap leads to a smaller number of working days lost and rarely requires secondary procedures.

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Background: There are many options for scrotal reconstruction, each having its own benefits and drawbacks. In the last years, the introduction of the propeller flaps gained great popularity, while the use of groin flap as propeller in scrotal reconstruction remains anecdotal, with only a few cases reported in the literature. Objectives: In this research, we study the versatility of unilateral propeller groin flaps in the reconstruction of large scrotal defects. Patients and Methods: This study was done on 10 patients with scrotal defects who were admitted to the plastic unit of the general surgery department at Benha University Hospital from 2019 to 2021 for scrotal reconstruction. Results: All surgeries were successful with a mean operative time of 103.5 min, ranging from 90 to 130 min. All flaps survived well with no flap necrosis, and only one case showed flap congestion. Donor site healed well with the scar hidden in a natural crease, with no affection on the testicular functions. Conclusions: The use of groin flap as a propeller allows for free movement and rotation of the flap, which allows for better coverage of a large scrotal defect with good vascularity, lesser complications, no need for further operations to separate the pedicle, and the lowest donor site morbidity. Level of evidence: Level IV, therapeutic study.

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Background. The combination of first webspace and dorsal hand contracture is a challenging reconstructive problem. Complete soft tissue release results in a large wraparound defect that spans the radial side of the palm, first webspace, and the transverse dimension of the entire dorsal hand. In these situations local tissue is often compromised, and free flap reconstruction is commonly indicated. However, in cases where patients are unwilling or unable to undergo microsurgical reconstruction, regional tissue transfer provides an alternative reconstructive strategy. This case report describes a series of 3 patients with severe combined contractures of the first webspace and dorsal hand. Each patient was relatively contraindicated for local or free tissue transfer and was treated with 2-stage selective contracture release with progressive dorsal then volar defect creation and coverage using a pedicled groin flap. This operation requires thoughtful planning during soft tissue release to coordinate staged, dorsal then volar, defect creation with the progressive liberation of the groin flap at its distal and then proximal ends.

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Objective: To investigate the effectiveness of groin flap combined with medial plantar artery perforator flap (MPAP) for degree Ⅲ-Ⅳ defects of multiple fingers. Methods: Between January 2018 and June 2019, 12 patients with degree Ⅲ-Ⅳ defects of multiple fingers caused by crushing were admitted. There were 9 males and 3 females with a median age of 29 years (range, 16-42 years). The mean interval between the injury and admission was 3 hours (range, 1-9 hours). The injured fingers of 7 cases were index and middle fingers, 4 cases were middle and ring fingers, and 1 case was index, middle, and ring fingers. All fingers were taken thorough debridement and covered by the vacuum sealing drainage device during the emergency operation. The mean interval between the debridement and flap repairing was 18 hours (range, 12-36 hours). During the first-stage operation, the iliac bone graft was used to reconstruct bone frame, and the proximal interphalangeal (PIP) joint from the foot was transferred as the digital PIP joint, then the thin groin flap and MPAP were tailored to cover the dorsal and palmar defects, respectively. The size of the groin flap was 7.0 cm×4.5 cm-14.0 cm×9.0 cm, and the size of the MPAP was 8.0 cm×4.5 cm-14.0 cm×6.5 cm. The abdominal donor site was directly sutured, and the foot was repaired with full-thickness skin grafting. The flaps were separated into the finger shape at the second-stage. Results: All the flaps survived, and the wounds healed by first intention; the incisions in the donor site healed by first intention, and the skin grafts survived completely. All patients were followed up 12-18 months (mean, 16 months). At last follow-up, the injured finger was similar to the contralateral one in terms of texture, appearance, and color. The mean two-point discrimination was 8 mm (range, 6-10 mm), and the sensate level recovered to the S 3-S 4. According to the Michigan Hand Outcomes Questionnaire (MHQ), the reconstructed hand function was excellent in 8 cases and good in 4 cases. There was no complication in the donor sites. Conclusion: The degree Ⅲ-Ⅳ defects of multiple fingers were repaired by the groin flap and MPAP, and the reconstructed fingers can perform good texture and motion with being sensate, with less sacrifice on the foot.

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INTRODUCTION AND IMPORTANCE: The superficial circumflex iliac artery perforator flap is a widely used and acceptable option of free tissue transfer for small and large defects due to its ease of dissection and adjustable pedicle length. CASE PRESENTATION: Herein we present our experience with two similar cases of hand ulcers with differing aetiologies that were managed successfully at our tertiary centre by general surgeons to cover the defects in order to salvage the hand. CLINICAL DISCUSSION: The pedicle groin flap was first described in 1972 and still indicated and used widely in hand resurfacing. It has shown to be reliable with minimal peri-operative complications. CONCLUSION: Groin flap donor skin provides adequate skin for coverage with versatile skin, but come at a cost of specialize expertise, resources and risks.

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The distant tubed pedicle skin flap concept was introduced almost 100 years ago. It was previously considered the workhorse flap to reconstruct the face and upper limbs. Despite being considered an ancient reconstruction method, it is still widely used by many reconstructive surgeons. It is considered a versatile flap with a good outcome. This article presents two cases of soft tissue injuries in the upper limbs reconstructed using distant tubed pedicled groin flaps, one of the types of tubed pedicle flaps. This article highlights the relevance of the tubed distant pedicle flap in reconstructing the upper limb defects and its effectiveness in restoring function, even though the cosmetic outcome is not favorable.

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INTRODUCTION: Abdominal pedicled flaps are one of the options utilized in the reconstruction of complex hand defects. In this communication, the author presents a case report demonstrating a new technical tip which was utilized in a young child. IMPORTANCE: The technical tip will help closure of further hand defects utilizing the same flap. CASE PRESENTATION: An abdominal pedicled flap was used to reconstruct the dorsal aspect of the hand and wrist following a deep contact burn. An "extension" of the flap from the abdomen at the time of flap division was harvested and utilized to cover an adjacent defect in the fingers. CLINICAL DISCUSSION: Several technical tips in the utilization of the pedicled groin/abdominal flaps in hand reconstruction have been reported. The author presents another tip. CONCLUSION: When utilizing abdominal pedicled flaps for hand reconstruction, an "extension" of the flap from the abdomen at the time of flap division may be harvested. This "extension" may be utilized to cover further adjacent defects in the hand.

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In complete digital ring avulsions, amputation is usually carried out when replantation of the avulsed tissue is not an option or has failed. The purpose of this study was to report our experience in treating Urbaniak Class III degloved fingers using an ultra-thinned pedicled groin flap. Sixteen patients from ages 11 to 26 years were included. In all cases, the flexor digitorum superficialis tendon, extensor apparatus and proximal interphalangeal joint were intact. Rehabilitation included immediate active mobilization, with flap division at day 21. At a mean follow-up of 15 months, all patients but one were satisfied with the appearance. Two had mild subjective cold intolerance. No flap failure was recorded. The mean total active motion was 183° and the mean QuickDASH score was 8.8/100. Patients recovered S1 sensibility according to the Mackinnon and Dellon classification. The ultra-thinned groin flap has proved to be a reliable technique for non-replantable ring avulsions.Level of evidence: IV.

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OBJECTIVE: To investigate the effectiveness of groin flap with external oblique aponeurosis in repair of tendon and skin defects of dorsal foot. METHODS: Between October 2016 and January 2020, 12 patients with compound tissue defects of the dorsal foot caused by trauma were treated. There were 9 males and 3 females, with a median age of 42 years (range, 32-65 years). The size of the skin defects ranged from 8 cm×5 cm to 12 cm×8 cm. All wounds were accompanied by extensor tendon injury, including 6 cases of extensor hallucis longus tendon defect, 5 cases of extensor digitalis longus tendon defect, and 3 cases of extensor digitalis longus tendon and extensor digitorum brevis defects. The interval between injury and admission was 1-6 hours (mean, 3 hours). After admission, the wounds were thoroughly debrided, and the groin flap with external oblique aponeurosis was used to repair the skin and tendon defects in the second stage. The size of skin flap ranged from 10 cm×6 cm to 13 cm×9 cm, and the size of the external oblique aponeurosis ranged from 5.5 cm×3.0 cm to 8.0 cm×5.0 cm. The wounds at donor sties were sutured directly. RESULTS: All flaps survived completely without significant complications. All incisions of the recipient and donor sites healed by first intention. All patients were followed up 16-24 months (mean, 18 months). The flaps were satisfactory in appearance and soft in texture. At last follow-up, 9 cases were excellent and 3 cases were good according to the American Orthopaedic Foot and Ankle Society (AOFAS) metatarsophalangeal-interphalangeal joint scale criteria. The toe function was satisfactory. The line scar was left without hernia or other morbidity on the donor site. CONCLUSION: The groin flap with the external oblique aponeurosis can repair the tendon and skin defects of the dorsal foot, with concealed donor site, easy dissection and adjustable thinness, as well as the enough tough aponeurosis.

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The main issues pertaining to oncological surgery of the musculoskeletal system are tumour resection with sufficient margins, and the coverage of inherent defects. We report the use of a pedicled cutaneous groin flap as coverage for a trochanteric defect following an oncological resection of a grade III pleomorphic soft tissue sarcoma in a 75-year-old patient. This flap is not routinely used in the coverage of a defect in this region. The interest of this original process lies in its technical ease, and in the possibility of lifting the flap directly after resection, without changing the set-up.

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The article presents outcome of treatment of 31 patients, 28 men and 3 women, at a mean age of 37 years with excessive soft tissue defects within the hand, which were fitted with groin flaps. Long-term outcomes were assessed at a mean of 3,7 years following surgery (range 3-10) in 18 patients (58%) in a form of phone interview. Results. All flaps eventually healed, however complications occurred in 8 patients (26%). At a follow-up assessment most of the patients complained of slight pain when using the hand. Only 2 patients achieved full range of motion of the fingers in the operated hand, and remaining 16 reported various degree of limited fingers movements, both flexion and extension. None of patients considered his/her hand fully dexterous and a mean quickDASH score was 21,5 points what shows moderate impairment of hand function. The poorest outcomes were achieved in patients with tissue defects in fingers and in those who had performed simultaneous tendon repair. The results of this study show that a groin flap is useful in reconstruction of large and moderate tissue defects in the hand, which do not fit for covering by conventional methods.

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Objective:To observe and summarise the clinical effect of free groin flap in repairing of soft tissue defects in extremities, and to explore the selection of main vessel in a flap.Methods:From January 2018 to January 2021, 146 patients with soft tissue defects in extremities were treated with free groin flaps in the Department of Hand and Microsurgery, Guangxi Guilin Xing'an Jieshou Orthopaedic Hospital. There were 126 patients with traumatic wound and 20 with chronic ulcer. In addition, 86 of the patients with bone fracture and exposure of internal fixator, 18 with tendon, nerve or artery injuries or defects. There were 6 patients with severe infection and other 3 with deep dead space. The sizes of wound ranged from 2.0 cm×3.0 cm to 25.0 cm×6.0 cm. The flap was the same size as the wound and not enlarged. Firstly, the superficial branch of superficial iliac circumflex artery was explored as the axial artery for all the flaps, then the blood supply vessels of the flap were selected according to the availability of the axial artery. The size, course, adjacent and possible length to be freed of the axial artery and the accompanying veins of a flap were recorded. The donor sites were directly sutured and closed. All patients were included in the postoperative follow-up at outpatient clinic.Results:Free groin flap were used to repair the wounds in all patients. However, the main blood supply vessel of the flap was not constant, and it was often required to adjust the way of flap harvesting. Superficial circumflex iliac artery was taken as the axial vessels in 141 patients (96.6%), among them, 133 cases(94.3%) had the superficial branch as the axis and 5 cases (3.6%) had deep branch as the axis. Three patients (2.1%) had the bone and soft tissue defects reconstructed with vascularised iliac mosaic osteocutaneous flap with superficial circumflex iliac artery as axial vessel and 5 cases(3.4%) had the superficial epigastric artery as axial vessel. The axial arteries were measured as follow: the superficial branch of the superficial circumflex iliac artery was 0.5-0.9 mm in diameter and 7.0-9.0 cm in length, the outer diameter of the deep branch was 1.2-1.4 mm and 9.0-11.0 cm in length, and the outer diameter of superficial epigastric artery was 1.0-1.6 mm and 8.0-11.3 cm in length. All the flaps survived smoothly after surgery and the follow-up period ranged 6-40 (mean 26) months. The texture of the flaps was soft with good function.Conclusion:Free groin flap can be used to repair soft tissue defects in extremities. The main axial vessel is the superficial branch of the superficial circumflex iliac artery, followed by the deep branch or the trunk. The superficial abdominal artery can also be used as an axial vessel. Under the circumstances, the flap design needs to be adjusted without changing the supply area