ABDOMINAL POCKET FLAP-GRAFT FOR COMPLEX DIGITAL SOFT-TISSUE DEFECTS: A THREE-CASE REPORT AND NARRATIVE REVIEW OF THE LITERATURE

Complex digital soft-tissue defects with exposed bone, tendons, or joints remain a challenging reconstructive problem. Local and regional flaps may be insufficient for extensive or circumferential defects, while free-tissue transfer requires microsurgical expertise, suitable recipient vessels, and appropriate resources. The abdominal pocket flap-graft is a staged pedicled technique that provides vascularized soft-tissue coverage without microsurgical anastomosis.
We report three clinical cases managed with abdominal flap-grafting. The first was a 23-year-old man with circumferential degloving of the ring finger and exposure of bone and flexor and extensor tendons; the finger remained attached to the abdomen for 23 days and complete flap survival was obtained, with preserved digital mobility after separation. The second was a 16-year-old girl with traumatic distal phalanx amputation of the index finger and exposed bone; abdominal pocketing was chosen to preserve digital length. The finger remained attached for 25 days, with complete flap survival but limited postoperative mobility. The third was a 40-year-old woman with deep burns of the dorsal second, third, and fourth fingers; after necrosectomy exposed phalanges and tendons required immediate coverage. An abdominal flap with separate tunnels was used, followed by staged weaning; full finger function was recovered at four months, although flap bulk required secondary defatting.
A narrative review of the literature was undertaken to place these cases in the context of contemporary hand reconstruction. Abdominal-based pedicled flaps remain useful in selected patients with extensive defects, compromised or unavailable recipient vessels, multiple-surface injuries, or limited access to microsurgery. Their principal limitations are staged surgery, immobilization, discomfort, bulk, and postoperative stiffness. Contemporary series suggest that physiotherapy of the attached hand may be feasible in selected configurations and may reduce stiffness.
The abdominal pocket flap-graft therefore remains a salvage and reconstructive option for selected complex digital defects. Careful patient selection, flap design, protection of the pedicle, early rehabilitation when technically feasible, and realistic counseling regarding staged reconstruction are essential.