Vascularized Perifascial Areolar Tissue-augmented Superficial Circumflex Iliac Artery Perforator Flap as an Adhesion-tolerant Functional Gliding Interface.

Background: Postoperative adhesions can impair reconstructions involving mobile structures. Perifascial areolar tissue (PAT) has been used for wound healing and nonvascularized interposition, but its role as a vascularized gliding interface remains underexplored. Methods: This retrospective clinical case series reviewed 6 patients who underwent vascularized PAT-augmented superficial circumflex iliac artery perforator (SCIP) flap reconstruction between 2018 and 2023. PAT was harvested in continuity with the SCIP flap pedicle and used prophylactically to create a gliding interface in 3 cases and therapeutically as an anti-tethering interface in 3 cases. Outcomes included structure-specific clinical findings and adhesion-related symptom severity on an 11-point numeric rating scale (NRS), when applicable. Results: The cohort included 4 male patients and 2 female patients, with a median age of 50 years (range, 34-68 y) and median follow-up of 24 months (range, 10-60 mo). Reconstructed structures included extensor tendons, the median nerve, the facial nerve, the larynx, and the lateral femoral cutaneous nerve; 1 patient had prior radiotherapy. All flaps survived, with no flap-related complications or adhesion-related secondary procedures. Therapeutic cases improved from a median preoperative NRS value of 9 to values of 1, 0, and 1, respectively, at final follow-up. Prophylactic cases had a final NRS value of 0 and no clinically evident restricted gliding or tethering. Conclusions: Vascularized PAT-augmented SCIP flaps may provide an anti-adhesion/gliding interface for selected reconstructions involving mobile structures. Larger comparative studies are required.