Hiding in Plain Sight: The Abdominal Donor Site as the New Workhorse for Superthin and Ultrathin Flaps

Document Type

Conference Proceeding

Publication Date

9-2026

Publication Title

Plastic and Reconstructive Surgery. Global Open

Abstract

Problem Addressed: Extremity reconstruction requires thin, pliable tissue to restore contour and permit early functional recovery. This challenge is amplified in obese patients, where commonly used donor sites such as anterolateral thigh and superficial circumflex iliac artery perforator flaps often remain bulky even when elevated in a superthin plane and may require skin grafting for closure at larger sizes. Secondary debulking procedures delay rehabilitation and increase morbidity. Despite offering the largest skin reservoir and the ability for primary closure, the abdominal donor site is rarely used for extremity reconstruction due to concerns of excessive thickness. Technique: We describe a systematic approach to harvesting superthin (suprascarpal) and ultrathin (subdermal) abdominal free flaps based on the superficial inferior epigastric artery (SIEA) and deep inferior epigastric perforator (DIEP) systems. For ultrathin reconstruction, the SIEA flap is preferentially used given its axial vascular anatomy within the subdermal plane, allowing uniform elevation without perforator skeletonization. Superthin flaps are elevated at the level of Scarpa’s fascia, reliably perfusing large skin paddles while discarding deep adipose tissue. When required, DIEP flaps are elevated using antegrade or retrograde perforator dissection to achieve similar thinning. Flaps can be designed across the hemiabdomen to accommodate large or irregular defects and are inset with standard microsurgical technique. Donor sites are closed primarily via panniculectomy, and the contralateral abdominal vessels provide immediate access to vascular graft material when needed. Outcomes: Fourteen patients underwent reconstruction of extremity defects ranging from 6 to 900cm2 (mean 198.9 cm2 ). Mean flap thickness was 1.03 cm compared to a native abdominal thickness of 4.92cm. There were no flap losses. All donor sites were closed primarily. Complications included two hematomas, two infections requiring debridement, and one venous thrombosis requiring revision. Two patients underwent secondary debulking. All patients achieved durable coverage with favorable contour and functional outcomes.

Volume

14

Issue

S4

First Page

13

Last Page

13

Comments

Michigan Academy of Plastic Surgeons Annual Meeting, July 12-15, 2026, Mackinac Island, MI

DOI

10.1097/01.GOX.0001276732.92602.f0

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