Occasionally, in areas of the body where there is minimal skin laxity, orthopedic hardware can become exposed and infected. These areas where little skin laxity exists can often not tolerate the swelling associated with infection. As a result, the hardware beneath may become exposed. The Plastic & Reconstructive surgeon then borrows tissue from either an adjacent or distant site on the body to replace this tissue.
Often a VAC dressing is placed on the wound to serve as a controled suction mechanism to remove any bacteria. Once the wound is clean, a flap is performed to cover the exposed hardware and prevent infection. In this case the chest wall skin is raised and the proximal forearm wound is brought to the chest wall.
The chest wall skin is elevated based on the intercostal vessels and perforators.
The chest wall skin is then sutured to the lateral and medial aspects of the proximal forearm defect to cover the exposed hardware.
The patient remains with his arm by his side for a range of 5 to 10 days while the flap now receives its blood supply from the forearm skin. Viability of the skin paddle can be checked by placing a clamp across the chest wall flap and occluding the blood flow. If the flap remains pink, it is viable and the chest wall flap can be transferred to the forearm.
Once the chest wall flap is divided, there is brisk bleeding from the forearm skin paddle. The open medial aspect of the wound is now closed.
Finally, the expanded skin from the chest wall can be returned to successfully close the chest wall wound.
