title: A new plane of elevation: the superficial fascial plane for perforator flap elevation.
abstract: BACKGROUND
  The aim for microsurgical reconstruction has broadened from achieving functional to also providing good esthetic outcomes. The perforator flaps are widely used for this goal. However, perforator flaps can still be bulky especially to resurface the skin defect. We hypothesized that elevation from the superficial fascial plane can obtain a thin and viable flap.
  
  
  METHODS
  In this retrospective study, we report consecutive perforator flaps elevated at the superficial fascial plane from November 2007 to July 2013. Total of 304 flaps which were 196 superficial circumflex iliac perforator (SCIP) flaps, 81 anterolateral thigh (ALT) flaps, and 27 gluteal artery perforator (GAP) flaps were reviewed.
  
  
  RESULTS
  The patient group composed of 189 male and 115 female patients with an average age of 35.8 years. The average body mass index was 23.5 kg/m(2) (range, 15.91-34.57 kg/m(2)). All 304 flaps were successfully elevated with this approach with at least one viable perforator. The thickness averaged approximately 6 mm for ALT flap (range, 4-11 mm), 5 mm for SCIP flap (range, 3-12 mm), and 8.5 mm for GAP flap (range, 5-11 mm). Complete survival was noted in 282 flaps, partial loss of flaps requiring secondary procedures in 6 cases, partial loss healing secondarily in 8 cases, and total loss in 9 cases. During the average follow-up of 34 months, secondary debulking procedures were required in six flaps.
  
  
  CONCLUSIONS
  This new approach of elevation on the superficial fascia is reliable, provides a viable tissue, and is able to obtain a thin flap achieving good functional and esthetic outcome.
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors.forename: Joon Pio
authors.initials: JP
authors.lastname: Hong
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Choi
authors.affiliation: Department of Plastic Surgery, Ewha Woman's University Hospital, Seoul, Korea.
authors.forename: Hyunsuk
authors.initials: H
authors.lastname: Suh
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors.forename: Dewi Aisiyah
authors.initials: DA
authors.lastname: Mukarramah
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors.forename: Talal
authors.initials: T
authors.lastname: Tashti
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors.forename: Kyungjin
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Plastic Surgery, Ulsan University Hospital, University of Ulsan, Ulsan, Korea.
authors.forename: Chiseoun
authors.initials: C
authors.lastname: Yoon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002081:Buttocks / Q000098:blood supply; D002648:Child; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013848:Thigh / Q000098:blood supply; D016896:Treatment Outcome