(1)
Yotsuya Medical Cube, Chiyoda-ku, Tokyo, Japan
Basic Principles
The abdomen, the scapular region and the inguinal region are the most common areas used for fat that can be harvested as transplant tissue with a vascular pedicle. All of these can be harvested as skin flaps and the skin part can be de-epithelized.
Augmentation can also be used for the fascia flap, however can be difficult as the surgeon cannot know during surgery how much the swelling will go down post-operation.
Selectable Flaps and Surgical Procedures
Groin flapScapular flapAbdominal flapAnterolateral thigh flapThe difficulty level of each surgical procedure is shown subsequent to the procedure title (e.g., Level of Difficulty: 2). The levels range from 1 to 5, with level 1 indicating a preliminary level and level 5 indicating a very advanced level.
24.1 Free Vascularized Groin Fat Graft (Level of Difficulty: 4)
Information
Vascular pedicle Superficial circumflex iliac blood vessel (at distal end branches into the superficial branch and deep branch, and superficial branch enters the flap). Length is 1.5–2 cm.
Size The width is around 10–15 cm centered around the inguinal ligament, and the length is up to about 25–30 cm, two times the length from the femoral artery to the anterior superior iliac spine
Advantage Donor site can be sutured closed primarily and isn’t obvious. Skin flap is comparatively thin, and large skin flap can be harvested.
Disadvantage Often variations in the path of the superficial circumflex iliac artery. The vascular pedicle is short and thin (0.5 mm). Fat tissue in the medial side of the flap (medial side of the femoral artery) is thick
Caution When detaching the medial side of the anterior superior iliac spine, if going too deep, the lateral cutaneous nerve of the thigh can be damaged, so care is required.
24.1.1 Operation Procedures
