The clinical application of subdermal vascular network flaps and their supercharged versions

We report on two types of subdermal vascular network (super-thin) flaps and their 'supercharged' versions that we have developed. In essence, these flaps are a narrow-pedicled occipito-cervical (OC) flap and an intercostal cutaneous perforator (ICP) flap. Further, the OC flap can be classified into 3 types: an occipito-cervico-dorsal (OCD) flap, an occipito-cervico-shoulder (OCS) flap, and an occipito-cervico-pectoral (OCP) flap. We have clinically used both these flaps in 25 cases, in which 5 supercharged OCD flaps and 1 supercharged ICP flap were also included, and report on the merits of these flaps below: 1) Both flaps are narrow pedicled and have a thinned, wide, fan- shaped distal area. The thinned portion covers from a half to two-third of the distal area. Narrowing the pedicle widens the arc of rotation, so that their usefulness is increased; 2) Our OC flaps, based on the ramus inferior occipital artery, and our ICP flaps, based on the intercostal artery, as well as their respective supercharged versions, were found to be clinically useful. 3) In the distal area of a large flap graft, inhibiting the flow from the flap's bloodstream and the grafting bed is thought to be effective in making the graft 'take.' Further, since this form of flap grafting is similar to grafting a well-maintained skin specimen, our grafting method is particularly suited for the repair of hypertropic scars and scar contractures of mobil areas of the skin, such as the face, neck, arms, and hands, and this form of grafting may become the future method for treating such defects. 4) By supercharging these flaps distally and providing microvascular augmentation, large flaps with good subcutaneous networks that will safely 'take' can be extended distally, thereby increasing the scope of flap therapy.