Vascularized Perifascial Areolar Tissue-augmented Superficial Circumflex Iliac Artery Perforator Flap as an...

Postoperative adhesions can impair reconstructions involving mobile structures. Perifascial areolar tissue (PAT) has been used for wound healing and nonvascularized interposition, but its role as a vascularized gliding interface remains underexplored.

This retrospective clinical case series reviewed 6 patients who underwent vascularized PAT-augmented superficial circumflex iliac artery perforator (SCIP) flap reconstruction between 2018 and 2023. PAT was harvested in continuity with the SCIP flap pedicle and used prophylactically to create a gliding interface in 3 cases and therapeutically as an anti-tethering interface in 3 cases. Outcomes included structure-specific clinical findings and adhesion-related symptom severity on an 11-point numeric rating scale (NRS), when applicable.

The cohort included 4 male patients and 2 female patients, with a median age of 50 years (range, 34-68 y) and median follow-up of 24 months (range, 10-60 mo). Reconstructed structures included extensor tendons, the median nerve, the facial nerve, the larynx, and the lateral femoral cutaneous nerve; 1 patient had prior radiotherapy. All flaps survived, with no flap-related complications or adhesion-related secondary procedures. Therapeutic cases improved from a median preoperative NRS value of 9 to values of 1, 0, and 1, respectively, at final follow-up. Prophylactic cases had a final NRS value of 0 and no clinically evident restricted gliding or tethering.

Vascularized PAT-augmented SCIP flaps may provide an anti-adhesion/gliding interface for selected reconstructions involving mobile structures. Larger comparative studies are required.