Influence of BMI, Age, and Gender on the Thickness of Most Common Thinned Flaps

Abstract

Background: Since the description of superficial fascia flap harvesting, a new window of opportunity has been open in obese patients, where a higher subcutaneous thickness of tissue is present. To our knowledge, the impact of body mass index on superficial fascial flaps has not been reported. Methods: We recruited 122 patients from April 2019 to January 2020. From these patients, the 3 most common thinned flaps were selected: the superficial circumflex iliac perforator flap; the anterolateral thigh flap at the perforator A, B, and C; and the thoracodorsal flap. Two vertical measures were registered: the distance from the skin to the superficial fascia, and from this point to the deep fascia. Results: The average flap measurement presented here was within the range, as previous clinical studies. The superficial fatty layer thickness in the superficial circumflex iliac perforator and anterolateral thigh flap was somewhat similar in thickness between overweight and obese patients, showing a minimal increase with higher body mass index. The anterolateral thigh flap was found thicker among women, and no statistical difference was shown between age groups in any of the flaps. Conclusions: A better understanding of the fat layers’ thickness will result in better planning, minimizing secondary debulking procedures, decreasing operative time, and reducing general complications among obese patients. Thus, a better understanding of flap structure and physiology in obese patients will lower complications and give more predictable results.

Proximal peroneal perforator flap, cadaveric study, and clinical applications for shallow defect reconstructions

“…Although the anatomical variability of the SCIP has been much overcome, flap thickness is dependent on patient gender and BMI. Because superficial fat layer is less influenced by these factors (Hanson‐Viana et al, 2021), flap elevation requires a suprafascial approach demanding surgical dexterity. Suprafascial ALT free flap is another thin workhorse flap but is difficult to harvest with a relatively long and large pedicle.…”

“…There are varying reports on maximum flap width for donor site closure without skin graft. Traction range is affected by skin thickness and elasticity, which vary by individual characteristics such as gender (Firooz et al, 2017; Hanson‐Viana et al, 2021) or BMI (Hanson‐Viana et al, 2021; Iacopi et al, 2020). While we have seen donor sites of up to 6 cm be closed without complications, skin thickness varies by patients and relevant factors must be taken into account in designing and repairing donor sites.…”

“…There are varying reports on maximum flap width for donor site closure without skin graft. Traction range is affected by skin thickness and elasticity, which vary by individual characteristics such as gender (Firooz et al, 2017;Hanson-Viana et al, 2021) or BMI (Hanson-Viana et al, 2021;Iacopi et al, 2020).…”

The Superficial Circumflex Iliac Artery Perforator Flap for Devastating Hand Injuries in Obese Patients

“…To that end, we describe the use of the superficial circumflex iliac artery perforator (SCIP) flap, which provides a thin, pliable flap with a reliable vascular pedicle, large donor site, and excellent cosmesis of the donor site with minimal morbidity. This flap was initially described in 2004 by Koshima et al 9,10 Given the lack of adiposity in the SCIP as compared with the ALT in a progressively heavier American population, 11 we find it a more appropriate option for hand and upper extremity coverage. In this report, we present the first series on the SCIP flap for upper extremity blast injury coverage in North America.…”