Superficial circumfix iliac artery pure skin perforator-based super thin flap for hand and finger reconstruction

Publication date: Available online 26 March 2016
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mitsunaga Narushima, Takuya Iida, Nobuyuki Kaji, Takumi Yamamoto, Hidehiko Yoshimatsu, Hisako Hara, Kazuki Kikuchi, Jun Araki, Shuji Yamashita, Isao Koshima
For hand and finger reconstruction, thin and flexible skin coverage is ideally required. A free flap is one of surgical options used for large defects. However, a flap that contains the fat layer is bulky. Several debulking surgeries are often needed aesthetically and functionally. To overcome this disadvantage, we herein report our experience of six cases of hand and finger reconstruction using a pure skin perforator (PSP) flap concept. A PSP flap is a thin skin flap that is vascularized by a perforator branch penetrated dermis. The thickness of the PSP flap could be approximately 2 mm or less as needed. As a flap pedicle, the superficial circumflex iliac artery and superficial inferior epigastric artery were used. Secondary defatting operations were not required. For the success of PSP flap elevation, we applied three techniques: the microdissection technique for vessel separation, thin flap elevation at the superficial fascial layer, and the temporary clamping method. Temporary clamping was applied for the main trunk of pedicle vessels during debulking to prevent unwanted bleeding, which allowed us to freely perform three-dimensional defatting. Using these three techniques, the PSP flap can be elevated and adjusted for complex contouring of the hand and finger. Although the use of the PSP flap requires further study, the PSP flap is an effective, super thin flap with the advantages of both a skin graft and perforator flaps.



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