Muscle free flaps with full-thickness skin grafting: Improved contour over traditional musculocutaneous free flaps

Occasionally, the aesthetic contour of a musculocutaneous flap can be improved by using the skin paddle as a full-thickness skin graft to cover the free muscle flap. In three patients, traditional musculocutaneous free flap coverage of wounds would have resulted in excess soft tissue bulk. To optimize final contour, the subcutaneous tissue was excised, and the skin replaced as a full-thickness skin graft. Problems with postoperative flap monitoring and skin graft take were not encountered. This technique offers the microsurgeon a simple method to optimize the aesthetic results of composite free tissue transfer.