Fasciocutaneous Flaps

Excerpt

Fasciocutaneous flaps, also known as axial flaps, comprise skin, subcutaneous tissue, and deep fascia, devoid of muscle components. Aesthetically and functionally, these flaps possess several advantages over both musculocutaneous and muscle-only flaps due to the thin, pliable nature of the transferred tissue. Pontén's pioneering work in 1981 introduced fasciocutaneous flaps for leg reconstruction. His research underscored the significance of incorporating the deep fascia for the survival of leg flaps, challenging the conventional approach of relying solely on random pattern blood supplies from the subdermal plexus. Pontén reported that with fasciocutaneous flap elevation, the length-width ratio could easily be extended from 1:1 to 2-3:1, significantly expanding reconstructive possibilities while minimizing the risk of skin necrosis. Subsequently, fasciocutaneous flaps gained popularity as reliable options to cover bone and tendons in the lower leg and elsewhere.

In the following years, many more authors expanded the clinical applications and indications for fasciocutaneous flap transfer while refining the understanding of their anatomical bases. Haertsch and Barclay et al were the first to recognize that including fascia within these flaps preserves the longitudinal anastomotic vascular networks, especially the suprafascial plexus, thereby increasing flap survivability. Cormack and Lamberty further classified fasciocutaneous flaps based on their vascularization patterns. Despite advancements in techniques like perforating vessel-based flaps and microvascular free tissue transfer, fasciocutaneous flaps remain advantageous due to their simplicity and reliability, serving as valuable salvage options when other methods fail.