The reversed dermis flap

doi:10.1016/S0007-1226(78)90062-0

British Journal of Plastic Surgery

Volume 31, Issue 2, April 1978, Pages 131-135

https://doi.org/10.1016/S0007-1226(78)90062-0 Get rights and content

Abstract

The reversed dermis principle of Hynes has been applied to flaps. There are 2 main varieties: the direct bridge pedicle flap and the turn-over local flap but the same principle might occasionally be useful in free flaps.

Reference (5)

HynesW.
The skin dermis graft as an alternative to the direct or tubed flap
British Journal of Plastic Surgery
(1954)
MauriceD.G. et al.
Repair of a pharyngocutaneous fistula
British Journal of Plastic Surgery
(1975)

There are more references available in the full text version of this article.

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Split skin-subcutaneous resurfacing technique for Apert hand reconstruction
2022, Journal of Plastic, Reconstructive and Aesthetic Surgery
Reverse Dermis Flap for Coverage of Distal Leg and Ankle Defects
2021, Journal of Foot and Ankle Surgery
Citation Excerpt :
It is useful in complex patients as it allows an easy recuperation with an early start of weightbearing and rehabilitation without complicated wound dressing changes. Reverse dermis flaps are random flaps that have been used since 1970s (15-17), having been called in very different ways: local turnover flap, local inturned flap and reverse dermis or dermal flap. Also, quite different operative techniques have been described.
Soft tissue defects of the distal third of the leg and ankle, which frequently expose tendon, bone or osteosynthesis material, are difficult to cover and pose a major challenge to the plastic surgeon. Traditional reconstructive options for this region usually require complex flaps which made them unsuitable for elderly patients or those with multiple comorbidities. We hereby present the reverse dermis flap as an easy and reliable choice to cover this type of wounds and refer our experience in 9 cases in which clinical, operative, and follow-up data were recorded. Of the 9 flaps performed, 8 survived completely and 1 presented a partial flap necrosis, requiring additional surgery. No other operative procedure was required. In conclusion, the reversed dermis flap is a simple, quick, noninvasive, and safe technique for coverage of noble structures such as tendon or bone in the distal third of the leg that every plastic surgeon should incorporate in his surgical armamentary.
Evolution and refinements of a dorsal adipofascial digital artery perforator flap
2020, Injury
Citation Excerpt :
Cross-finger flaps remain popular flaps in the clinical setting. Initially the reversed dermis flap and later the subcutaneous cross finger flap were described in the utilization for the reconstruction of dorsal digital defects [16,17]. The main problems were the formation of epithelial cysts at the first flap, and stiffness of the joints due to the immobilization of both fingers for at least two weeks.
Soft tissue defects to the dorsum of fingers are quite demanding for the reconstructive surgeon especially in the cases that bone and extensor tendons are exposed. The purpose of our study was to describe a new adipofascial island flap by a single dorsal digital perforator (dorsal adipofascial digital artery perforator, DADAP).
Methods: In 8 patients (7 male, 1 female), 12 soft tissue defects to the dorsum of the fingers (3 index, 6 middle, 2 ring, 1 little finger), ranging from 1 × 2 cm to 2 × 4 cm, were reconstructed using the DADAP flap.
The flaps sizes ranged from 2.5 × 1.5 cm to 8 × 3 cm. The defects were covered in 9 cases by a propeller-rotation type flap and in 3 by a turn-over flap. In 4 cases a tendon graft was used to cover the tendon defect and in 3 cases an open joint was reconstructed. In all cases a splint thickness skin graft (SSG) covered the flaps. Mean follow-up was 18 months. One patient developed distal tip flap necrosis and was treated conservatively. Delayed wound healing with partial SSG failure due to haematoma was observed in 3 fingers, but the underlying flap was viable and complete healing was achieved by secondary intention.
The use of DADAP flap is a fast, safe and reliable solution to cover the defects of the dorsum of fingers and can be performed under local anaesthesia as a day surgery.
Adipofascial, Transposition, and Rotation Flaps
2020, Hand Clinics
Citation Excerpt :
Hynes1 in 1954 showed that deepithelialized skin, when turned upside down, will readily take as a free graft. Ivan Pakiam2 in 1973 applied the same principle and used reverse dermis flaps to cover defects over dorsum of digits, ankle joint, dorsum of the foot, and even a deltopectoral defect following a forelimb avulsion. Erdogan Atasoy3 in 1978 has been using the same principle to reconstruct full-thickness dorsal skin defects with reverse cross finger flaps.
Vascularized dermal autograft for the treatment of irreparable rotator cuff tears
2018, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
The risk of infection is of primary concern, as this flap involves a de-epithelialized tissue placed adjacent to the joint for reconstruction. The present technique is functionally similar to the “turnover flap,” which is a common procedure in reconstructive plastic surgery for trauma as well as at-risk areas.19,24,29,30 A de-epithelialized turnover flap has been used in reconstructive foot and ankle surgery in cases of osteomyelitis in which hardware is present.26
Irreparable rotator cuff tears (IRCTs) are a challenging problem with diverse treatment modalities. We propose a technique for the treatment of IRCTs in which a vascularized dermal autograft is transferred to the posterosuperior region of the rotator cuff using the supraclavicular artery (SCA) island flap.
Dissection of 11 fresh cadavers (19 shoulders) was performed, and the SCA island flap was harvested in all specimens. A full-thickness posterosuperior rotator cuff defect was created, and the flap was tunneled under the acromion and secured into position over the defect using multiple suture anchors. Simulated flap perfusion was then assessed, and flap measurements were recorded.
There were 4 male and 7 female cadavers (19 shoulders). Flap perfusion was assessed in 10 shoulders. On average, the flap thickness was 4.7 mm (range, 3.5-7.1 mm); width, 32.6 mm (range, 25.5-38.0 mm); and length, 169.2 mm (range, 132.0-235.0 mm). The average distance from the flap tip to the Neviaser portal was 76.2 mm (range, 48.0-99.6 mm), and that from the flap tip to the anterolateral acromial edge was 54.1 mm (range, 29.5-75.1 mm). The pedicle-to-footprint distance was 113.7 mm (range, 88.5-147.0 mm). The average flap length exceeded the pedicle-to-footprint distance by 55.5 mm (range, 43.5-88.0 mm), indicating adequate excursion of the flap. All flaps demonstrated adequate simulated perfusion after fixation.
The SCA island flap may be an option for a vascularized dermal autograft for IRCTs, as shown in this cadaveric study. This illustrates a possible technique with vascular viability.
The reverse cross finger flap
2016, Journal of Hand Surgery

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