THE USE OF FILLET FLAPS IN UPPER EXTREMITY RECONSTRUCTION BY L. SCOTT LEVIN, MD, FACS, DETLEV ERDMANN, MD, AND GUNTER GERMANN, MD, PhD ln unnsua! cases. extensiue sojt-tissue defects 0/ the /(IJIJer extremity melY be reconstructed uith major fillet flaps. \Ve discuss the me 0/these flellJS CIS derived from the experience in using them on 8 selected patients d/(ring a 5-y«Ir period cit 2 institmions. Etiology 0/ injlll)' for tcbicb these flaps are ideal indnde trauma and tumor resection or reconstruction. Defect locations iududed the sboulder. combined defects 0/ the shoulder plm neck. arm or chest wall. /(pper arm. and forearm. The majority 0/flaps require microsnrgica! [ree-tissue transfer. Unlike the classic spare-part, fillet-fiellJ concept, the partial or complete couiersiou 0/ an elf/atomicetlly intact arm Celli be IJer/ormed. especially ill tmuor recoustruaiou. Meljor fillet fiellJS represent a minab!« option ill the armamentarinm for reconstruction in the /(IJller extremity u.it]: either pedided or free-tissue transfers iutolring extensive tissue defects. Copyright CD 2002 by the AmeriCClJl ociety for IIIgel)' 0/ the Hand F illet is a synonym for strip or band, describing a boneless piece of muscle or skin. The term fillet flap is commonly used to designate a spare part as a pedicled or free flap in reconstructive surgery.' Classic fillet flaps are defined as axial pattern flaps harvested from amputated, discarded, or otherwise nonfunctioning From the Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, NC; and the Klinikfur Hand, Plastische und Rekonstruk- tive Chirurgie, Schwerbrandverletztenzentrum, BG, Unfallklinik Ludwigshafen, Unioersitiu Heidelberg, Ludwigshafen, Germany. Address reprint requests to Detlev Erdmann, MD, Clinical Associate, Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center 3181, Durham, NC 27710. E-mail: levinOO l@mc.duke.edu Copyright © 2002 by the American Society for Surgery of the Hand 1531-0914/02/0201-0006$35.00/0 doi:10.1053/jssh.2002.31119 or nonsalvageable parts.? However, in some clinical cir- cumstances, intact extremities have to be converted into fillet flaps to facilitate complex reconstruction. Although these flaps do not represent spare parts and are raised from anatomically intact limbs, they still can be defined as fillet flaps. A clarified definition and classification was recently introduced. Therefore, 3 categories of fillet flaps exist: type A, finger and toe flaps; type B, limb flaps; and type C, flaps from intact body parts. Flaps can be trans- ferred as pedicled (subclassification 1), island (subclassi- fication 2), and microsurgical (subclassification 3). 2 SURGICAL TECHNIQUE T he technique for harvesting fillet flaps of the upper extremity is based on the principles of harvesting free-tissue transfer. In all cases, a major vascular axis is identified that contributes blood sup- JOURNAL OF THE AMERICAN SOCIETY FOR SURGERY OF THE HAND' VOL. 2, NO.1, FEBRUARY 2002 39