Hafiz, A., NAwar, A., Sami, A. (2019). A Modification in the Shape of the Skin Island of Fasciocautaneous Flaps in the Distal Extremities. The Egyptian Journal of Plastic and Reconstructive Surgery, 43(1), 153-157. doi: 10.21608/ejprs.2019.65174
Ahmed Abdel Salam Hafiz; Ahmed NAwar; Ahmed Maher Sami. "A Modification in the Shape of the Skin Island of Fasciocautaneous Flaps in the Distal Extremities". The Egyptian Journal of Plastic and Reconstructive Surgery, 43, 1, 2019, 153-157. doi: 10.21608/ejprs.2019.65174
Hafiz, A., NAwar, A., Sami, A. (2019). 'A Modification in the Shape of the Skin Island of Fasciocautaneous Flaps in the Distal Extremities', The Egyptian Journal of Plastic and Reconstructive Surgery, 43(1), pp. 153-157. doi: 10.21608/ejprs.2019.65174
Hafiz, A., NAwar, A., Sami, A. A Modification in the Shape of the Skin Island of Fasciocautaneous Flaps in the Distal Extremities. The Egyptian Journal of Plastic and Reconstructive Surgery, 2019; 43(1): 153-157. doi: 10.21608/ejprs.2019.65174
A Modification in the Shape of the Skin Island of Fasciocautaneous Flaps in the Distal Extremities
The Department of General Surgery, Plastic Surgery Unit, Faculty of Medicine, Cairo University
Abstract
Background: Distally based (reversed flow) fasciocautaneous flaps are used for coverage of distal extremity soft tissue defects. However, there is a high incidence of venous congestion that may lead to partial or total flap loss. Various modifications for these flap design have been made aiming to improve flap survival. Aim of Work: In this paper, a tongue like extension from the skin island was done aiming to improve its versatility and decrease complication rate especially venous congestion. Patients and Methods: Eight patients (five males and three females), average age thirty years old. Most cases where post traumatic, one case necrotizing fasciitis of heel, one case with squamous cell cancer of dorsal hand skin. Five patients underwent reversed sural flap and three patients underwent radial forearm flap. Results: All cases had viable flaps with good wound healing. However female patients complained of the scarring later on. One case of reversed sural flap had minimal distal congestion that improved later on. Conclusion: Advantage of this modification is that it acts to stabilize the critical vascular pattern of the pedicle during its axial rotation minimizing the post insetting vascular problem. It improves the venous drainage through the subdermal and subcutaneous venous plexuses and limits the excess kinking of the fascial pedicle. This tongue of tissue can also serve as an extra tissue to be used for coverage in some cases. It also has a superior cosmetic appearance when compared to skin grafting of the pedicle. The use of this modified technique can be extended to any island flap that has to pass through a tight tunnel to reach the defect.
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