The role of local fascial flaps as an adjunct to free flaps.

Local fascial flaps independently are a versatile option, reliable when properly designed, and technically simple to execute especially when compared to microsurgical tissue transfers. Although free flaps continue to be the method of choice to repair major distal extremity defects, for smaller wounds it could be preferable to use a local fascial flap instead. In reviewing the 194 local fascial/fasciocutaneous flaps used by us since 1982, 46 were specifically used in lieu of a free flap that had been initially considered. Only two of these failed to achieve their objective, indeed then requiring salvage by a free flap. In addition, a local fascial flap was concurrently advantageous as a second flap on 17 occasions to simplify coverage of the microanastomoses, to facilitate closure of the free flap donor site, or as the backup method for a failed free flap with limb preservation. Therefore, 32.5% (63 of 194) of all of our local fascial flaps were either used as a substitute for or improved the overall success rate as an integral part of our microsurgical experience during this same time period.