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Exposed Artificial Plate Covered With Perifascial Areolar Tissue as a Nonvascularized Graft

Ito, Tomoyuki, MD*; Akazawa, Satoshi, MD*; Ichikawa, Yuichi, MD*; Yamamoto, Yusuke, MD*; Aoyama, Shohei, MD*; Kiuchi, Tomoki, MD*; Nakao, Junichi, MD*; Onitsuka, Tetsuro, MD; Araki, Jun, MD*; Nakagawa, Masahiro, MD*

Plastic and Reconstructive Surgery – Global Open: February 5, 2019 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000002109
Latest Articles: PDF Only

Summary: Perifascial areolar tissue (PAT) is a loose connective tissue on deep fascia, such as on the groin, thigh, or temporal region, which has abundant vascular plexus and mesenchymal stem cells. Nonvascularized PAT grafts can survive even on hypovascular wound beds. Therefore, PAT grafting is a possible alternative to conventional flap surgery to cover exposed bone or artifacts. In this article, we describe 2 cases of PAT grafting for the treatment of skin ulcers with exposed bone and artificial plate after mandible reconstruction. After negative-pressure wound therapy, PAT was used to covering exposed artificial plate for both cases, and a skin graft onto the PAT graft was performed in 1 case. The ulcers improved in both cases without recurrence. The gold-standard treatment of intractable ulcers and fistulas with an exposed tendon, bone, or artifact is coverage by a well-vascularized skin flap. However, PAT grafting has advantages in similar situations, occasionally together with skin grafting and/or negative-pressure wound therapy, because it is technically simple and less invasive.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan

Division of Head and Neck Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.

Published online 5 February 2019.

Received for publication September 12, 2018; accepted November 27, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the Shizuoka Cancer Center Hospital.

Jun Araki MD, PhD Masahiro Nakagawa, MD, PhD, Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shunto-gun, Shizuoka 411–8777, Japan, E-mail:

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.