A systematic approach for improvement of the donor sites of fasciocutaneous flaps

Fasciocutaneous flaps as a group have been maligned more often for fear of potential donor-site morbidity than any concern for reliability. Typically, this is related to limitations imposed by the skin graft necessary to clos e most such donor sites, as admittedly has been required for the majority ( 52 percent) of our 313 flaps over the past 2 decades. Nevertheless, 48 perc ent did not require skin grafts, reflecting the adoption of strategies that evolved to minimize this shortcoming. These included use of fascia-only fl aps, primary closure with small composite flaps, direct closure possible by use of rotation or advancement flaps ol a second flap, or a delayed closur e utilizing either pretransfer or posttransfer tissue expansion. Donor-site complications were actually fewest when a skin graft primary closure was p ossible and occurred at the same rate regardless of body region. However, b ecause the skin-grafted donor site was always a cosmetic compromise, a syst ematic approach to circumvent its use whenever possible is emphasized as a valuable tool to enhance the role of fasciocutaneous flaps as a vascularize d flap alternative.