Background?The aim for microsurgical reconstruction has broadened from achieving functional to also providing good esthetic outcomes. The perforator flaps are widely used for this goal. However, perforator flaps can still be bulky especially to resurface the skin defect. We hypothesized that elevation from the superficial fascial plane can obtain a thin and viable flap. Method?In this retrospective study, we report consecutive perforator flaps elevated at the superficial fascial plane from November 2007 to July 2013. Total of 304 flaps which were 196 superficial circumflex iliac perforator (SCIP) flaps, 81 anterolateral thigh (ALT) flaps, and 27 gluteal artery perforator (GAP) flaps were reviewed. Result?The patient group composed of 189 male and 115 female patients with an average age of 35.8 years. The average body mass index was 23.5 kg/m2 (range, 15.91?34.57 kg/m2). All 304 flaps were successfully elevated with this approach with at least one viable perforator. The thickness averaged approximately 6?mm for ALT flap (range, 4?11 mm), 5?mm for SCIP flap (range, 3?12 mm), and 8.5?mm for GAP flap (range, 5?11 mm). Complete survival was noted in 282 flaps, partial loss of flaps requiring secondary procedures in 6 cases, partial loss healing secondarily in 8 cases, and total loss in 9 cases. During the average follow-up of 34 months, secondary debulking procedures were required in six flaps. Conclusion?This new approach of elevation on the superficial fascia is reliable, provides a viable tissue, and is able to obtain a thin flap achieving good functional and esthetic outcome.

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Background:Malignant peripheral nerve sheath tumors (MPNSTs) constitute a group of soft tissue neoplasm with neuroectodermal origin. Most cases are small at presentation and only some have been described reaching giant dimensions.Case Description:We report two cases that were diagnosed and treated as giant MPNST of the scalp. Both patients had extensive lesion on the head with intracranial infiltration. Microsurgical resection was indicated and a vascularized free flap was used to cover the defect. During follow-up the tumors recurred and further surgical excision treatment by adjuvant radiation therapy was performed.Conclusion:MPNSTs of the scalp are rare neoplasm of the peripheral nervous system. They are aggressive lesion that can recur and their management requires a multimodality approach.