title: Clinical application of subdermal areolar tissue and superficial fascia graft as a new material for coverage of small exposure of bone cortex or orthopaedic fixation device.
abstract: BACKGROUND
  The presence of cortical bone, tendon that has been exposed by defects, may result in infection or osteomyelitis. In such cases, perifascial areolar tissue grafting (PATG) may be performed as a minimally invasive surgical procedure. However, perifascial areolar tissue (PAT) is located deep in the subcutaneous layer. It was considered that grafting of the superficial vascular network might enable less invasive surgery. This study reports use of subdermal areolar tissue (SAT) and superficial fascia (SF) to close avascular areas.
  
  
  METHODS
  This study treated eight areas of exposed bone, tendon, or orthopaedic fixation device in seven patients treated in the department between 2010-2013. The patients included five men and two women aged 15-80 years. Subdermal areolar tissue grafting (SATG) was performed on four areas, and superficial fascia grafting (SFG) on the remaining four areas. In all cases, split thickness skin graft (STSG) was used to cover the grafted tissue in a single procedure.
  
  
  RESULTS
  The tissue grafted successfully in seven areas, and primary engraftment of the skin grafts was also achieved in three areas treated with SATG and one area treated with SFG. Additional skin grafting was performed to achieve closure in one site treated with SATG and two sites treated with SFG. The tissue graft became necrotic in one site treated with SFG. There were no problems at any donor sites and no graft site infections or other complications.
  
  
  CONCLUSIONS
  SATG and SFG achieved good clinical results for the closure of exposed avascular tissue or artifacts.
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Tokyo Medical University Hospital , Tokyo , Japan.
authors.forename: Masahide
authors.identifier: http://orcid.org/0000-0002-8402-1268
authors.initials: M
authors.lastname: Gondo
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Tokyo Medical University Hospital , Tokyo , Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Matsumura
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Tokyo Medical University Hospital , Tokyo , Japan.
authors.forename: Katsueki
authors.initials: K
authors.lastname: Watanabe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005205:Fascia / Q000637:transplantation*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D040521:Subcutaneous Tissue / Q000637:transplantation; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation; D020858:Tissue and Organ Harvesting / Q000379:methods; D014945:Wound Healing / Q000502:physiology*; D014947:Wounds and Injuries / Q000473:pathology / Q000601:surgery*
keywords: Subdermal areolar tissue; cortical bone coverage; free graft; superficial fascia; vascular network