Free fillet flap transplantation using amputated upper limbs for shoulder defect coverage and joint function salvage in emergency treatment-A case report.

[INTRODUCTION AND IMPORTANCE] Severe limb trauma results in mangled extremities, amputation, uncovered wound and delayed healing. The rapid development of flap transplantation concept and technique leads to applications of free flap in the salvage of limb and articular appearance and functions. This report discusses the case of a patient with acute shoulder avulsion and smashed injuries and evaluates the feasibility and safety of free fillet flap transplantation in emergency treatment.

[CASE PRESENTATION] A 44-year-old man presented with acute traumatic severing injury to the left arm. We performed free fillet flap transplantation from the amputated forearms to retain the structure of shoulder joint and coverage of humerus in a patient who suffered from acute shoulder avulsion and smashed injuries. Moreover, we evaluated the long-term outcomes at 2-year follow-up and confirmed the functional adaptivity of proximal stump of the shoulder joint.

[CLINICAL DISCUSSION] The free fillet flap application is an important and advanced technique to cover large areas of skin and soft tissue defects in a mangled upper limb. It requires an experienced microsurgeon to achieve vessel reconnection, flap transfer and wound repair. In such an emergency case like this one, it calls for collaboration between different departments to work out a delicate and comprehensive plan in order to obtain the best possible result for saving patients.

[CONCLUSION] The free fillet flap transfer in this report is feasible and useful for shoulder defect coverage and joint function salvage in emergency treatment.