The Subdermal Approach for Harvesting Superficial Circumflex Iliac Artery-Based Pure Skin Perforator Flaps in Hand and Wrist Reconstruction.

Purpose: The pure skin perforator (PSP) flap technique offers a reliable solution for aesthetic limb reconstruction by reducing flap thickness to approximately 2 mm while preserving blood supply. The subdermal approach simplifies flap harvesting, reducing surgical time and donor site morbidity. This study aimed to evaluate the clinical outcomes and feasibility of using the subdermal approach for harvesting superficial circumflex iliac artery (SCIA)-based PSP flaps in reconstructing hand and wrist defects.

Methods: This retrospective study included 11 patients with hand or wrist skin defects, who underwent SCIA-PSP flap reconstruction using the subdermal approach between March 2022 and February 2024. Flap design and harvesting were guided by preoperative high-frequency ultrasonography, with dissection at the subdermal plane using a surgical microscope. Postoperative care included monitoring flap viability and assessing aesthetic outcomes at 6 months using a five-point Likert scale.

Results: A total of 13 flaps were harvested, with two flaps harvested in cases 5 and 6, respectively. The flap sizes ranged from 11 to 98 cm² (mean: 47.5 cm²). Harvest times ranged from 37 to 140 minutes (mean: 70.1 minutes). Twelve flaps were successfully transferred, with one experiencing partial necrosis. Aesthetic outcomes at 6 months showed favorable results, with mean scores of 4.5 for overall aesthetic outcome and 4.7 for contour and texture match.

Conclusions: The subdermal approach for harvesting SCIA-PSP flaps is a feasible and effective technique for hand and wrist reconstruction, yielding excellent aesthetic results. Further research is needed to confirm its broader clinical applications.

Type of study/level of evidence: Therapeutic IV.