The subcutaneous pedicle flap: widening of its applications

The subcutaneous pedicle flap is useful for reconstruction of a relatively small defect, and there have been many reports on its use in the facial region. With careful manipulation and thought given to the selection of the patient, it is also applicable to the trunk and extremities. During the last 7 years, we have treated 80 patients who had subcutaneous pedicle flaps applied to various parts of the body (57 on the face, 12 on the trunk, and 11 on the extremities). Eleven representative patients are presented in this article. Based on our experience, we are now confident that the subcutaneous pedicle flap is useful to reconstruct a free border or transient area of different tissues, such as the eyebrow, eyelid, lip, and nose. In the trunk, e.g., in the buttock and the breast, it is useful to reconstruct the natural convexity. We prefer using the V-Y advancement type of subcutaneous pedicle flap rather than the transposition flap. To increase the mobility of the advancement flap, the distal portion of the flap is undermined just below the layer of the subdermal plexus. This may prevent postoperative bulkiness and facilitate the reconstruction of natural contour.