title: Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction.
abstract: For hand and finger reconstruction, thin and flexible skin coverage is ideally required. A free flap is one of the surgical options used for large defects. However, a flap containing the fat layer is bulky. Several debulking surgeries are often needed for aesthetic and functional purposes. 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 penetrating the dermis. The thickness of the PSP flap could be approximately ≤2 mm as needed. The superficial circumflex iliac artery and superficial inferior epigastric artery were used as a flap pedicle. 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, superthin flap with the advantages of both skin graft and perforator flaps.
authors.affiliation: Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. Electronic address: sancho-ps@umin.ac.jp.
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.affiliation: Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Iida
authors.affiliation: Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kaji
authors.affiliation: Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.affiliation: Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Hara
authors.affiliation: Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Araki
authors.affiliation: Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D019074:Epigastric Arteries / Q000601:surgery; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000002:abnormalities / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007564:Japan; D008297:Male; D042282:Microdissection / Q000379:methods*; D008875:Middle Aged; D061525:Perforator Flap; D019651:Plastic Surgery Procedures / Q000379:methods*; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: Finger; Hand; Perforator; Reconstruction; Superficial circumflex iliac artery; Thin flap