Abstract
Background: Perifascial areolar tissue is located above the deep fascia and it contains various cells that promote wound healing and angiogenesis as well as small vessels with a dense horizontal network. Owing to these properties, it can be used as a scaffold to achieve sufficient granulation even in poorly vascularized tissues. This narrative review article describes and analyzes the current literature on the clinical applications of perifascial areolar tissue.
Methods: Perifascial areolar tissue was found to be associated with clinical applications for wounds through a PubMed literature search, using “perifascial areolar tissue” as the keyword. We analyzed and compared the procedures performed at our institution, including one-stage perifascial areolar tissue combined with skin grafting and negative wound pressure therapy.
Results: The published reports included the histological characteristics and clinical applications of 13 articles on perifascial areolar tissue. Over the years, it has been used for refractory wounds such as bone, tendon, and joint exposures, as well as for filling dead spaces or fluid leaks. Both perifascial areolar tissue and skin grafts were successfully used in 8 of the 10 cases when adequate granulation tissue was promoted with a large overlapping area of perifascial areolar tissue against poorly vascularized tissue using a one-stage procedure.
Conclusions: The efficacy of perifascial areolar tissue has been reported to be satisfactory in refractory wounds owing to the promotion of wound healing by the contained cells and vascular network; however, it might be limited in the case of a wide exposure of avascular tissue on the wound surface.
Operative procedure of one-stage perifascial areolar tissue (PAT) and skin grafting combined with negative pressure wound therapy (NPWT) at our institution.
Fullsize Image
(a) Harvest PAT and full-thickness skin grafts from the external oblique and inguinal/lower abdominal regions, respectively, through the same incision. The red dotted line indicates the inguinal fold. (b) The PAT is located between the subcutaneous fat and the external oblique muscle fascia. (c) The harvested PAT in the required size. (d) The procedure is applied to the ulcer with exposed tissue, such as tendons, bone, and joint surfaces, which inhibit wound healing. (e) A large overlap of the area between the PAT and the exposed area inhibiting wound healing is required to promote revascularization from the granulation tissue into the PAT. The yellow dotted line indicates the PAT that overlaps the tendon. (f) A meshed 3:1 split-thickness skin made from harvested full-thickness skin is grafted onto the PAT and the remaining ulcer. (g) Finally, a VAC
® device is applied with a continuous negative pressure of 50 to 75 mmHg for one week. (h) Postoperative image showing the PAT and skin graft on the 12th day after surgery. Both the PAT and simultaneous skin graft are adapted sufficiently. (i) Three months after surgery. Epithelialization is smoothly achieved within one month and there is no severe contracture of the dorsum of the foot and toes.
