CIRCUMFERENTIAL FOREARM FASCIOCUTANEOUS FREE-FLAP RECONSTRUCTION OF FOREQUARTER AMPUTATION CHEST-WALL RESECTION USING SIMULTANEOUS EXTRAANATOMIC REVASCULARIZATION (SEAR)

Background: This report describes a technique in which temporary extra -anatomic revascularization of an amputated part was used to preserve a free flap while tumor resection and chest wall reconstruction were p erformed. Methods: A patient with multiple local recurrences of basosq uamous carcinoma of the shoulder underwent forequarter amputation with en bloc resection of the upper chest wall. During the resection, an e lbow disarticulation of the amputated limb was performed. The vascular pedicle of the amputated forearm was joined to the dorsalis pedis ves sels of the foot. Following completion of tumor resection and chest wa ll reconstruction, the forearm was disconnected from the foot and re-a nastomosed to thoracic vessels, and a circumferential fasciocutaneous free flap was then harvested and inset. Results: No ischemic flap comp lications occurred, and the patient recovered well. Ample time was aff orded for complete tumor resection with negative margins and prostheti c reconstruction of the chest wall. Conclusions: The technique of temp orary, simultaneous extra-anatomic revascularization of an amputated p art for later free flap harvest may be helpful in avoiding potentially long flap ischemia times in selected complex oncologic resections.