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. 2018 Jul;45(4):304-313.
doi: 10.5999/aps.2017.01529. Epub 2018 Jul 15.

Thin elevation: A technique for achieving thin perforator flaps

Hyung Hwa Jeong  1 , Joon Pio Hong  1 , Hyun Suk Suh  1
Affiliations

Thin elevation: A technique for achieving thin perforator flaps

Hyung Hwa Jeong et al. Arch Plast Surg. 2018 Jul.

Abstract

Elevating thin flaps has long been a goal of reconstructive surgeons. Thin flaps have numerous advantages in reconstruction. In this study, we present a surgical method for elevating a thin flap and demonstrate the safety of the procedure. A retrospective review was performed of the electronic medical records of patients who underwent thin flap elevation for lower extremity reconstruction from April 2016 to September 2016 at the Department of Plastic Surgery of Asan Medical Center. All flaps included in this study were elevated above the superficial fascia. A total of 15 superficial circumflex iliac artery free flaps and 13 anterolateral thigh free flaps were enrolled in the study. The total complication rate was 17.56% (n=5), with total loss of the flap in one patient (3.57%) and partial necrosis of the flap in four patients (14.28%). No wound dehiscence or graft loss at the donor wound took place. Elevation above the superficial fascia is not inferior in terms of flap necrosis risk and is superior for reducing donor site morbidity. In addition to its safety, it yields good aesthetic results.

Keywords: Free tissue flaps; Lower extremity; Subcutaneous tissue.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.. Thickness of SCIP flap with thin elevation
The elevated flap can be as thin as 5 mm. SCIP, superficial circumflex iliac artery perforator.
Fig. 2.
Fig. 2.. Pretibial reconstruction with thin ALT free flap
(A) Preoperative findings of the defect. (B) Design of the anterolateral thigh (ALT) free flap. (C) Harvested free flap that was elevated above the superficial fascia. (D) A follow-up photograph taken 8 months postoperatively.
Fig. 3.
Fig. 3.. Toe reconstruction with thin SCIP free flap
(A) Preoperative defect. (B) Superficial circumflex iliac artery perforator (SCIP) free flap design. (C) Intraoperative photograph during elevation. The flap was elevated above the superficial fascia. (D) Immediate postoperative photograph. (E, F) A follow-up photograph taken 6 months postoperatively. (G) A photograph of the donor site taken 6 months postoperatively.
Fig. 4.
Fig. 4.. Forefoot reconstruction with thin SCIP free flap
(A, B) Preoperative photograph of the defect. (C) Harvested superficial circumflex iliac artery perforator (SCIP) free flap. (D) Photograph taken during elevation. The flap was elevated above the superficial fascia. The deep fat was scanty because of the patient’s low body weight. A follow-up photograph taken 1 year postoperatively.
Fig. 5.
Fig. 5.. Diabetic foot coverage with SCIP free flap
(A) Preoperative photograph. (B) Harvested superficial circumflex iliac artery perforator (SCIP) free flap. (C) Immediate postoperative photograph. (D) A photograph taken after debridement of the partially necrotized portion of the flap. Negative pressure wound therapy was applied for 5 months. (E) A photograph of the totally healed flap. SCIP, superficial circumflex iliac artery perforator.
See this image and copyright information in PMC

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