Layered Fasciocutaneous Flap Effects in Complex Wound Repair

Abstract and Introduction

Abstract

Introduction: Repair of complex wounds of the lower extremity remains challenging for clinicians. When repairing complex wounds, it is necessary to customize the skin flap to simultaneously repair both the superficial soft tissue defect and the deep dead space wound.

Objective: This case series describes the use of a layered fasciocutaneous flap with pedicled perforator to repair complex wounds of the lower extremity.

Materials and Methods: Three cases with complex wounds of the lower extremity underwent repair using layered fasciocutaneous flap, and clinical efficacy was observed.

Results: In cases 1 and 3, complete survival of the layered flaps was achieved. In case 2, congestion measuring 1 cm × 1 cm occurred at the distal end of the skin paddle, followed by superficial skin ulceration, which healed 2 weeks after a dressing change.

Conclusion: These findings indicate that a layered fasciocutaneous flap with pedicled perforator can be used to repair complex wounds of the lower extremity.

Introduction

Repair of complex wounds of the lower extremity remains challenging for clinicians.^[1,2] Complex wound reconstruction requires the use of customized flap designs. While repairing a superficial tissue defect wound, it is also necessary to fill the deep dead space.^[2] Advances in the field of microsurgery prompted the development of a variety of chimeric free flaps for use in repairing complex wounds of the lower extremity.^[3,4] However, this type of surgical repair usually requires the surgeon to be proficient in micromanipulation techniques.^[1,3,4] When repair of a complex wound of the lower extremity does not involve the need for functional reconstruction (eg, a small bone defect cavity with soft tissue defect, or a deep tissue defect cavity with soft tissue defect), the authors of the present study propose the use of a layered fasciocutaneous flap with pedicled perforator. Flap design and surgical procedure are described herein.