title: Combination of a total free forearm flap and a sensate local flap for preservation of the shoulder girdle in massive, nonreplantable upper extremity injuries.
abstract: BACKGROUND
  After massive upper extremity injuries, prosthetic use might be complicated by the formation of pressure ulcerations. Especially the coverage with insensate free flaps may predispose the patient for developing chronic ulcerations when using an upper extremity prosthesis. This complication may be reduced when sensate local flaps are used to cover bony prominences.
  
  
  METHODS
  A new operative technique is described.
  
  
  RESULTS
  Immediate sensate soft tissue coverage improves prosthetic fitting. Successful manipulation of the prosthesis can be quickly achieved with a decreased risk for pressure ulceration.
  
  
  CONCLUSIONS
  This challenging procedure helps to achieve durable and sensate coverage of bony prominences. The use of local sensate tissue to cover bony prominences reduces the risk for pressure ulceration when wearing a prosthesis. Areas where prosthetic use causes only low pressure and shearing forces are adequately covered with free flaps. Immediate sensibility of local flaps allows prosthetic fitting and use as soon as wound healing has occurred. Return to work is thus expedited.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kantonspital St. Gallen, Switzerland. rafael.jakubietz@kssg.ch
authors.forename: Rafael G
authors.initials: RG
authors.lastname: Jakubietz
authors.forename: Michael G
authors.initials: MG
authors.lastname: Jakubietz
authors.forename: Danni F
authors.initials: DF
authors.lastname: Kloss
authors.forename: Joerg G
authors.initials: JG
authors.lastname: Gruenert
mesh_terms: D000062:Accidents, Occupational; D000328:Adult; D000673:Amputation, Traumatic / Q000209:etiology / Q000601:surgery*; D001134:Arm Injuries / Q000209:etiology / Q000601:surgery*; D005542:Forearm / Q000601:surgery; D006801:Humans; D008297:Male; D008906:Mining; D013524:Surgical Flaps