Abstract
Introduction: Soft tissue defects of the upper extremity pose significant challenges in hand surgery. While microsurgical advancements have expanded reconstructive options, pedicled groin and random-pattern abdominal flaps remain valuable alternatives, particularly in resource-limited settings or when microsurgical techniques are contraindicated due to patient-specific factors such as comorbidities or previous flap failures. This study revisits these 'old friends' of reconstructive surgery, emphasizing their indications, techniques, and outcomes.
Methods: This retrospective study evaluated the clinical outcomes of 16 patients who underwent two-stage abdominal or groin flap surgeries between 2021 and 2023 for traumatic upper extremity injuries. Demographic data, injury characteristics, and surgical details were analyzed. Postoperative outcomes, including functional recovery, complications, and patient satisfaction, were assessed over a mean follow-up period of 13 months.
Results: Of the 16 cases, 14 achieved complete flap survival, with one partial and one near-total failure. Complications were observed in 43% of cases, primarily due to infections. Patients who underwent abdominal flaps experienced higher rates of shoulder stiffness, whereas total flap loss was more frequent with groin flaps. Functional recovery varied, with mild to moderate cold intolerance severity scores and limited sensory outcomes. Aesthetic satisfaction remained suboptimal, with only a few patients reporting satisfactory results.
Conclusion: Random-pattern abdominal and pedicled groin flaps are effective for upper extremity soft tissue reconstruction, particularly when microsurgical options are unavailable. However, challenges such as complications, sensory recovery, and aesthetic satisfaction necessitate further refinement in surgical techniques and multidisciplinary care.

Key words: Soft tissue defects, Upper extremity reconstruction, Abdominal flap, Groin flap, Hand surgery