Complex reconstruction of a massive shoulder and chest wall defect: de-bone appétit flap.

We report the use of a fillet of upper arm pedicled flap, which has not been previously reported in the literature. The fillet of upper arm flap follows the principle of "spare parts" surgery, and can provide vascularized soft tissue coverage for defects of the shoulder and the chest wall when the upper extremity cannot otherwise be salvaged, such as in cases of radical tumor excision. The fillet of upper arm pedicled flap was used to successfully cover a large shoulder and chest wall defect measuring 25 cm x 15 cm. This "spare parts" reconstructive technique has several advantages over the previously reported forearm free flap, including minimal need for microsurgery and the ability for expansion to cover larger defects. This case demonstrates effective use of fillet of upper arm flaps in reconstruction of large defects of the shoulder and chest wall.