The Subdermal Free Flap for Reconstruction in Patients with Obesity | Dr. Daniel Gould

Dr. Daniel Gould co-authored this research published in the Journal of Surgical Oncology, introducing the subdermal free flap as an approach for achieving thin soft tissue reconstruction in patients with obesity. Dr. Gould is confirmed as a co-author alongside Ketan M. Patel and Orr Shauly. 

Reconstruction of distal extremity wounds can be particularly challenging in patients with a high body mass index. Traditional skin and soft tissue flaps may contain several centimeters of fatty tissue, potentially creating excessive bulk when transferred to areas such as the lower leg or foot.

The authors explored a different anatomical plane for flap elevation, located superficial to Scarpa's fascia. By harvesting tissue within this plane, surgeons can create a considerably thinner flap while maintaining the vascular supply required for successful microsurgical transfer.

The report describes a 62-year-old woman with a BMI of 44.81 who presented with a chronic lower extremity wound. A thin suprascarpal flap, approximately one centimeter thick, was harvested from the thigh and transferred to reconstruct the defect. 

The transferred tissue healed successfully without reported wound-healing complications. The case demonstrated that an ultrathin reconstructive option could remain feasible even when a patient's body composition would ordinarily result in a substantially thicker conventional flap. 

The research contributes to the refinement of microsurgical reconstruction by demonstrating how careful selection of the anatomical dissection plane may help surgeons reduce flap thickness and achieve more appropriate soft tissue coverage in patients with obesity.