Pre-expanded Super-Thin Skin Perforator Flaps

Patients with severe postburn scar contractures underwent reconstruction of skin defects after scar excision with pre-expanded super-thin skin perforator flaps supplied primarily by perforators via the “bridging effect” from the branches of the adjacent arteries as 2-stage procedures. Pre-expansion is an innovative technique and may improve the anastomoses between subdermal vascular plexuses and extend the supplying area of these vessels to the flap. Such a flap becomes super thin, but with a prefabricated blood supply it can be used for reconstruction of skin defects of the face, neck, or other body part with improved functional and cosmetic outcomes.

Key points

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The ideal skin flap should be large enough for adequate coverage but thin enough to match the regional anatomy of each particular anatomic area.
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A super-thin skin perforator flap is created via pre-expansion during the first stage operation.
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A tissue expander is placed essentially under the subdermal vascular plexuses based on the location of identified 2 or more adjacent perforators.
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Our preferred technique can create a large super-thin skin flap that has prefabricated blood supply.
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The flap can be used to reconstruct a large surface skin defect with a “like-for-like” tissue.