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Complex defects of the forearm and arm are best reconstructed with free flaps. Free flaps are however not universally available. They require long operative time and may be contraindicated in patients with extensive injuries due to a lack of good recipient vessels. The alternatives to free flaps are distant flaps such as groin flaps, random abdominal flaps, thoracoepigastric flaps and paraumbilical perforator flaps. These are axial flaps that are limited by the angiosomes supplied by a given perforator or blood vessel. To improve the extent and reliabilities of the paraumbilical flaps, we incorporated two perforators in the flap.

Lateral Thoracodorsal Flap Revisited: An Underappreciated Workhorse