Suprafascial dissection of the pedicled groin flap: A safe and practical approach to flap harvest

• Published in: Microsurgery 2018-07, Vol.38 (5), p.458-465
• Main Authors: Abdelrahman, Mohamed, Zelken, Jonathan, Huang, Ren‐Wen, Hsu, Chung‐Chen, Lin, Chih‐Hung, Lin, Yu‐Te, Lin, Cheng‐Hung
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adult; Demographics; Dissection; Dissection - methods; Fascia; Female; Finger Injuries - surgery; Follow-Up Studies; Graft Survival; Groin - diagnostic imaging; Groin - surgery; Hand Injuries - surgery; Humans; Iliac Artery; Laser-Doppler Flowmetry; Male; Medical personnel; Microsurgery; Middle Aged; Necrosis; Negative-Pressure Wound Therapy; Patients; Perforator Flap - blood supply; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Replantation; Retrospective Studies; Surgery; Tissue and Organ Harvesting - adverse effects; Tissue and Organ Harvesting - methods; Transplant Donor Site - blood supply; Treatment Outcome; Young Adult
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.30238

Background The groin flap has been relied upon for more than 4 decades and is well suited for reconstruction of the mutilated hand. Classic groin flap harvest is subfascial and includes the superficial circumflex iliac artery (SCIA). SCIA perforator flaps have shown that one perforator is sufficient to supply a large flap without breaching fascia. Accordingly, we routinely preserve the fascia and rely wholly on the superficial branch of the SCIA, sparing the deep branch. We aim to investigate the safety of suprafascial flap elevation and encourage a paradigm shift in reconstruction with groin flap transfer. Methods Between 2008 and 2013, 77 hand injuries were treated with pedicled groin flap transfers. According to surgeons' preference, 49 flaps were elevated with conventional technique (“subfascial”) and 28 were harvested with suprafascial approach (“fascia sparing”). Demographic data including flap size, operative time, and outcome were reviewed in both approaches and compared. Results Suprafascial flaps were taken as large as 32 × 12 cm2 and subfascial flaps large as 30 × 10 cm2 (p = 0.08). Operative time was 268.2 ± 104.7 minutes in the suprafascial group and 227.4 ± 89.0 in the subfascial group (p = 0.14). One suprafascial flap (3.6%) had partial necrosis compared to four subfascial flaps (8.2%) (p = 0.65). All patients were followed for a minimum of six months. All the wounds finally healed without further flap reconstruction, and all the patients were back to the normal life with activities. Conclusion Suprafascial dissection is safe and does not adversely influence outcomes. Thinner flaps are expected to facilitate flap insetting and reduce revisionary debulking surgery. Level of Evidence III (Therapeutic)