Microsurgeon.org

An atlas of microsurgery techniques and principles.


Skin and Fasciocutaneous Flaps

Free skin and fasciocutaneous flaps are indicated for complex reconstruction of skin and fasciocutaneous defects of the head and neck, chest and abdomen, upper and lower extremities. This may involve applications as varied coverage of exposed vital structures or contour reconstruction such as breast reconstruction. Clearly the indications for skin and fascial flaps are numerous and varied.

We would classify a skin flap as containing skin and subcutaneous fat, while a fascial flap will contain fascia and may or may not contain skin as well. A radial forearm flap for instance is usually harvested as a fascial flap, taking the antebrachial fascia in continuity with the pedicle and skin. It can however be harvested as a skin flap, by dissecting the perforator to the skin through the fascia and leaving fascia behind in the forearm.

Selection of Skin or Fasciocutaneous Flaps over Other Types of Flaps

Skin flaps and fascia flaps are usually selected to follow Millard's principle of replacing tissue with like tissue. If a full thickness skin and fascia defect is created by tumor extirpation, skin flap with fascia would replace the defect with the same kind of tissue that has been lost. But, skin flaps have extended applications as replacements for mucosal tissue because mucosal donor tissue areas are few for large defects. Skin flaps are for instance excellent choices for intra-oral reconstruction or esophageal reconstruction.

Advantages of Skin and Fasciocutaneous Flaps

Skin and fascia flaps have many features that make them well suited to reconstruction of complex wounds. They are indicated to:

The quality and thickness of donor skin is easily evaluated by inspection and physcial examination. Doppler examination can often pinpoint areas to encompass with the harvest of tissue, and color can be matched to the recipient are by selecting a color matching donor.

Limitations

The fact that skin is removed with skin flaps necessitates donor area under tension or skin grafting of the donor site. This may make the donor area slow to heal or require immobilization to minimize donor area complications like skin graft loss of wound break down.

A slow healing donor area may delay chemotherapy after tumor excision.

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