Background: Distally based (reversed flow) fasciocautaneous
flaps are used for coverage of distal extremity soft
tissue defects. However, there is a high incidence of venous
congestion that may lead to partial or total flap loss. Various
modifications for these flap design have been made aiming
to improve flap survival.
Aim of Work: In this paper, a tongue like extension from
the skin island was done aiming to improve its versatility and
decrease complication rate especially venous congestion.
Patients and Methods: Eight patients (five males and
three females), average age thirty years old. Most cases where
post traumatic, one case necrotizing fasciitis of heel, one case
with squamous cell cancer of dorsal hand skin. Five patients
underwent reversed sural flap and three patients underwent
radial forearm flap.
Results: All cases had viable flaps with good wound
healing. However female patients complained of the scarring
later on. One case of reversed sural flap had minimal distal
congestion that improved later on.
Conclusion: Advantage of this modification is that it acts
to stabilize the critical vascular pattern of the pedicle during
its axial rotation minimizing the post insetting vascular
problem. It improves the venous drainage through the subdermal
and subcutaneous venous plexuses and limits the excess
kinking of the fascial pedicle. This tongue of tissue can also
serve as an extra tissue to be used for coverage in some cases.
It also has a superior cosmetic appearance when compared to
skin grafting of the pedicle. The use of this modified technique
can be extended to any island flap that has to pass through a
tight tunnel to reach the defect.