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Upper Arm Reconstruction
Clinical Presentation
A 55-year-old White female had residual sarcoma over her left upper arm after previous resection. She underwent a wide local excision of the sarcoma by the surgical oncology service. The plastic surgery service was asked to perform a soft tissue reconstruction after additional resection of residual sarcome. After the wide local excision, there was an 11 × 8 cm full-thickness skin and subcutaneous tissue defect down to the underlying muscles ( Fig. 16.1 ).
Operative Plan and Special Considerations
Based on the size and location of the skin defect over the lateral upper arm, a large adjacent skin rotational flap could be planned. The portion of the soft tissue defect could be closed directly after significant undermining and the rest of the defect would be reconstructed by the skin rotational flap. In this way, the most critical part of the wound could be covered by the more reliable tissue and the patient would have better overall reconstructive outcome. Although a skin graft-only procedure can be selected to close this defect, the resulting contour of the reconstruction would probably not be optimal. In addition, a direct skin graft to the underlying muscles may result in tethering, which would compromise the function of those muscles.
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