Turn over split fascial flap - a refinement for resurfacing shin defect

Moderate size defects of the shin of tibia are frequently encountered following trauma and infection. They may be associated with or without a fracture. Such defects require resurfacing by a flap. Many different types of flaps have been described but most of them proved to be more bulky than desired. Although these procedures cover the defects successfully the results they produce are not aesthetically appropriate. The flap looks bulkier because the native subcutaneous tissue is thin over the shin and distal leg. Hence a search for a vascularized tissue of minimal bulk for suitable resurfacing was initiated. A turnover fascial flap fulfilled the requirement. Such a flap can be made thinner by splitting its distal part into two layers while maintaining a common vascular fascial pedicle with both the layers of the fascia. This allowed a larger surface area to be covered. Such refinement is based on the following parameters (a) fresh cadaveric dissection, (b) demonstration of live microcirculation individually in the superficial and deep layers of the deep fascia and (c) intraoperative flourescein study of the split fascial flap. The technique has been used in 5 cases over the upper and middle third of the shin of tibia. The split fascial flap was turned over and inset in the defect and covered with a split skin graft. The donor site was primarily closed. The functional and aesthetic results were highly satisfactory. The follow up of 18 months proved the durability and usefulness of the flap.