Local Random Flap – Subcutaneous island Pedicle

 Subcutaneous Island Pedicle Flap

This is an island of skin having a subcutaneous pedicle which provides the blood supply. The movement of the flap depends on the ability of the subcutaneous tissues to stretch. It is useful in areas where there is a substantial thickness of subcutaneous fat, for example, the medial cheek or the calf. It is much less effective in areas of reduced subcutaneous fat, such as the back of the hands, forehead and scalp.

The flap is an isosceles triangle, whose height is one to two times the diameter or the length of the defect. In its basic design the triangular incision is carried through the skin and subcutaneous tissues creating an island of skin on a full thickness fat pillar. Obviously one cannot use this flap in areas where deep incisions through fat could damage motor nerves which lie superficially in the fascia adjacent to the fat. The flap advances on its mobile fatty bed and is secured to the opposite side of the defect. Closure of the secondary defect is side to side utilizing a V – Y repair. For larger defects, the islands are taken from the opposite sides.

It may help to reduce the bulk of the flap by undermining the flap on two pedicles extending laterally.