Methods of vascular pedicle coverage

Is split-thickness skin graft safe for coverage of the vascular pedicle in free tissue transfer?

INTRODUCTION

If the pedicle is compressed after microanastomosis during free flap reconstruction, additional tissue such as skin graft or vascularized flap is needed to avoid tension. Performing a skin graft directly on the vessel might cause considerable problems. We aimed to analyze the safety of skin grafting on the anastomosis site of the free flap.

PATIENTS AND METHODS

A total of 15 patients who underwent skin grafting on the anastomosis site were analyzed. The skin graft take-up rate and flap-related complications were evaluated postoperatively.

RESULTS

All involved sites were the extremities (10 hands and 5 feet). An anterolateral thigh free flap in six patients and a toe pulp free flap in nine patients were harvested. The mean follow-up period was 10.4 ± 6.2 months. The graft area for the pedicle was 2.8 ± 1.6 cm². The percentage of final graft take was 99.3 ± 1.2% at 30 days postoperatively without flap compromise.

CONCLUSION

During free flap surgery in the upper or lower extremities, inadequate pedicle coverage may occur easily. Applying a split-thickness skin graft in such cases can be safe and one of the simple methods.

Optimization of Microsurgery

The latissimus dorsi free flap is a workhorse for extremity reconstruction. One of its benefits is a long vascular pedicle that spans the zone of injury. However, it may be difficult to adequately cover this pedicle. Direct closure may be too tight, and skin grafting over the pedicle risks exposure if graft take is poor. We report a technique in which the serratus branch of the thoracodorsal artery and its overlying fascia are harvested en bloc with the thoracodorsal artery and latissimus muscle. This provides 2 flaps on a common pedicle that can easily be rotated to allow positioning and insetting. We successfully used this technique in the reconstruction of both upper and lower extremities. The serratus fascia provides excellent padded covering and is a good bed for skin grafting. The versatility of this hybrid flap will allow its use in a range of complex reconstructive procedures.