Beyond function: Aesthetic considerations in pedicled abdominal flaps for upper limb reconstruction.

Background: Pedicled abdominal flaps (PAFs) represent an established approach for reconstructing the upper extremity, offering robust coverage and minimal donor-site morbidity. Most studies focus on functional outcomes and complications; however, there is a paucity of literature examining patient and physician satisfaction regarding aesthetic results following reconstruction. Objective: This retrospective study aimed to assess pedicled abdominal flap efficacy and safety in upper limb reconstruction, examining flap survival, complications, aesthetic outcomes, and surgeon assessment. Methods: The study included 16 patients who underwent reconstruction using PAFs between January 2022 and February 2025. The distribution of vascular territories used for flap reconstruction was as follows: (SIEA) alone in one case (6.3 %), (SCIA) in eight cases (50 %), (PUP) flap in five cases (31.3 %), and a combination of SIEA + SCIA in two cases (12.5 %). Aesthetic outcomes were assessed via patient and physician satisfaction surveys. Additionally, complications and donor-site morbidity were analyzed. Results: The surgical outcomes demonstrated a high flap survival rate of 93.8 %, indicating generally favorable results. Wound infection occurred in 25 % of cases. Physicians generally reported higher satisfaction levels across most domains than patients, although both groups exhibited acceptable results. No major donor-site morbidity was observed. Conclusion: PAFs represent a reliable and efficient method for upper limb reconstruction, achieving favorable aesthetic outcomes with high flap survival and low complication rates. Notably, aesthetics emerged as a critical outcome domain, with patient and Physician evaluations highlighting their importance.