Clinical application of subdermal areolar tissue and superficial fascia graft as a new material for coverage of small exposure of bone cortex or orthopaedic fixation device

Abstract

Background: The presence of cortical bone, tendon that has been exposed by defects, may result in infection or osteomyelitis. In such cases, perifascial areolar tissue grafting (PATG) may be performed as a minimally invasive surgical procedure. However, perifascial areolar tissue (PAT) is located deep in the subcutaneous layer. It was considered that grafting of the superficial vascular network might enable less invasive surgery. This study reports use of subdermal areolar tissue (SAT) and superficial fascia (SF) to close avascular areas.

Methods: This study treated eight areas of exposed bone, tendon, or orthopaedic fixation device in seven patients treated in the department between 2010–2013. The patients included five men and two women aged 15–80 years. Subdermal areolar tissue grafting (SATG) was performed on four areas, and superficial fascia grafting (SFG) on the remaining four areas. In all cases, split thickness skin graft (STSG) was used to cover the grafted tissue in a single procedure.

Result: The tissue grafted successfully in seven areas, and primary engraftment of the skin grafts was also achieved in three areas treated with SATG and one area treated with SFG. Additional skin grafting was performed to achieve closure in one site treated with SATG and two sites treated with SFG. The tissue graft became necrotic in one site treated with SFG. There were no problems at any donor sites and no graft site infections or other complications.

Conclusion: SATG and SFG achieved good clinical results for the closure of exposed avascular tissue or artifacts.

Keywords:

• Subdermal areolar tissue
• vascular network
• superficial fascia
• free graft
• cortical bone coverage

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.