Suprafascial dissection of the pedicled groin flap: A safe and practical approach to flap harvest

Background: The groin flap has been relied upon for more than 4 decades and is well suited for reconstruction of the mutilated hand. Classic groin flap harvest is subfascial and includes the superficial circumflex iliac artery (SCIA). SCIA perforator flaps have shown that one perforator is sufficient to supply a large flap without breaching fascia. Accordingly, we routinely preserve the fascia and rely wholly on the superficial branch of the SCIA, sparing the deep branch. We aim to investigate the safety of suprafascial flap elevation and encourage a paradigm shift in reconstruction with groin flap transfer. Methods: Between 2008 and 2013, 77 hand injuries were treated with pedicled groin flap transfers. According to surgeons' preference, 49 flaps were elevated with conventional technique (“subfascial”) and 28 were harvested with suprafascial approach (“fascia sparing”). Demographic data including flap size, operative time, and outcome were reviewed in both approaches and compared. Results: Suprafascial flaps were taken as large as 32 × 12 cm ² and subfascial flaps large as 30 × 10 cm ² (p = 0.08). Operative time was 268.2 ± 104.7 minutes in the suprafascial group and 227.4 ± 89.0 in the subfascial group (p = 0.14). One suprafascial flap (3.6%) had partial necrosis compared to four subfascial flaps (8.2%) (p = 0.65). All patients were followed for a minimum of six months. All the wounds finally healed without further flap reconstruction, and all the patients were back to the normal life with activities. Conclusion: Suprafascial dissection is safe and does not adversely influence outcomes. Thinner flaps are expected to facilitate flap insetting and reduce revisionary debulking surgery. Level of Evidence: III (Therapeutic).