A New Plane of Elevation: The Superficial Fascial Plane for Perforator Flap Elevation

Abstract

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.

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

“…Selection of optimal flap type was based on the size and depth of the defect, the length of the pedicle, and patient posture during surgery. Flap elevation was performed according to the protocol of our institution [11][12][13]. The flaps used in the present study were anterolateral thigh flap, superficial circumflex iliac artery perforator flap, superior gluteal artery perforator flap, radial free forearm flap, posterior interosseous flap, and gracilis muscle flap.…”

The Thin bilateral and bipedicled DIEAP flap for axillary reconstruction in hidradenitis suppurativa

“…Suprascarpa's harvest of perforator flaps is an established technique [9,10]. Although it has -to the best of our knowledge -never been reported for a DIEAP flap before, we find it even easier than a TDAP, ALT or SGAP since the vertical fibrous septa are looser and less numerous, the lobules larger and the perforators constantly of large calibre, thus easy to visualize.…”

“…Originalarbeit eral authors, and the same holds true for thin flaps [9,10,[12][13][14][15][16][17]. Thus this is just another application of a well established technique.…”

“…The flap is raised above Scarpa's fascia in these cases. As described for the Antero Lateral Thigh (ALT), Superficial Circumflex Iliac Artery Perforator (SCIAP), TDAP and Gluteal Artery Perforator (GAP) flaps [9,10], the DIEAP flap can be raised in a supra-Scarpa's plane as well.…”

Practical Considerations for Perforator Flap Thinning Procedures Revisited

“…As a result, unresolved edema with inherent fibrosis created a bulky appearance. In a larger series, Hong et al [23] reported that six of 282 thin perforator flaps harvested at the superficial fascial plane required secondary debulking procedures.…”