A Modification in the Shape of the Skin Island of Fasciocautaneous Flaps in the Distal Extremities

Abstract

Background: Distally based (reversed flow) fasciocautaneousflaps are used for coverage of distal extremity softtissue defects. However, there is a high incidence of venouscongestion that may lead to partial or total flap loss. Variousmodifications for these flap design have been made aimingto improve flap survival.Aim of Work: In this paper, a tongue like extension fromthe skin island was done aiming to improve its versatility anddecrease complication rate especially venous congestion.Patients and Methods: Eight patients (five males andthree females), average age thirty years old. Most cases wherepost traumatic, one case necrotizing fasciitis of heel, one casewith squamous cell cancer of dorsal hand skin. Five patientsunderwent reversed sural flap and three patients underwentradial forearm flap.Results: All cases had viable flaps with good woundhealing. However female patients complained of the scarringlater on. One case of reversed sural flap had minimal distalcongestion that improved later on.Conclusion: Advantage of this modification is that it actsto stabilize the critical vascular pattern of the pedicle duringits axial rotation minimizing the post insetting vascularproblem. It improves the venous drainage through the subdermaland subcutaneous venous plexuses and limits the excesskinking of the fascial pedicle. This tongue of tissue can alsoserve as an extra tissue to be used for coverage in some cases.It also has a superior cosmetic appearance when compared toskin grafting of the pedicle. The use of this modified techniquecan be extended to any island flap that has to pass through atight tunnel to reach the defect.