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flank area and two incisions are made perpendicular to the long axis of the body to create the tunnel in which the limb will be slid.
• Position of the limb. Once the limb is positioned
into the tunnel, the cranial and caudal incisions are partially closed. No tacking sutures are placed to avoid damage to the underlying blood vessels.
• Flap section. After 10 days to 2 weeks, the dorsal and ventral pedicles are cut and the limb is freed from its attachments. In some occasions the pedicles are cut stepwise within 4 to 6 days.
• Closure. Once the flap has taken over the initial wound, it can be completely closed over the limb.
• Pain control, drainage and bandages are mandatory to allow a good healing.
Pros and cons
The main advantage of this technique is an-almost 100 % “flap take” with a full-thickness skin coverage. The main disadvantage is a staged procedure with 2 major surgeries and the discomfort for the patient having “one leg in the chest”. Complications include dehiscence, secondary infection and ankylosis.
Despite the paucity of literature, pouch flaps have been found to be very useful to cover large distally located limb deficits avoiding the combination of flaps and grafts.
An Urban Experience

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