Safety of Elevation from Superficial Fascial Plane versus Traditional Deep Fascial Plane for Flap Elevation in a Porcine Model

Abstract

Purpose: In a random fasciocutaneous flap, deep fascia was thought to play an essential role. However, studies have reported that the superficial fascial plane could be elevated safely in fasciocutaneous flaps. We studied a porcine model to evaluate whether a random fasciocutaneous flap could be elevated by the superficial fascial plane in a hemodynamically safe manner. Methods: A total of sixteen 3×9 cm proximal-based dorsal flank fasciocutaneous flaps were elevated by different planes: above the superficial fascial plane, below the superficial fascial plane and below the deep fascial plane. Distal flap necrosis and microangiography of each flap and histologic examination were evaluated. Results: Distal flap necrosis was not significantly different among the various elevated planes. Microangiography showed that the suprafascial plexus of the superficial fascia was the most frequent dominant blood supply in a random fasciocutaneous flap. Biopsy also showed that the dominant vessels were located in the suprafascial layer of the superficial fascia. Conclusion: The suprafascial plexus of the superficial fascia was the most frequently dominant blood supply in a random fasciocutaneous flap regardless of flap elevation plane. Therefore, the superficial fascia plane could be elevated safely in random fasciocutaneous flaps. In addition, even if without superficial fascia, fasciocutaneous flap can be elevated safely with inclusion of suprafascial plexus of the superficial fascia and this plane could be used as a flap debulking plane.