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Perifascial areolar tissue (PAT) is a thin membranous tissue with rich horizontal vascular plexus that is located on the deep fascia and is usually harvested from the deep fascia of the thigh and fascia of the external oblique muscle of the abdomen. We successfully treated lateral malleolar ulcers that were refractory to drug preparations and wound dressings for several years with PAT grafts using the Integra® Meshed Dermal Regeneration Template (Integra, Integra Life Sciences, Princeton, NJ). The subjects were two patients of elderly or many underlying illnesses with lateral malleolar ulcers caused by ischemia and chronic venous insufficiency that had remained uncured despite ongoing treatment with ointments, bFGF (Fiblast® Spray; Kaken Pharmaceutical Co. Ltd., Tokyo, Japan) and wound dressings. We performed surgery with debridement of the ulcer site and PAT graft placement on the defect, with Integra placed over the PAT. The PAT survived, and good dermal regeneration was achieved with Integra. On postoperative day 18, split-thickness skin graft was performed. Completely elastic and flexible skin was formed, resulting in reduced ulcer recurrence. One year postoperatively, the patients reported improved quality of life without recurrence. In elderly patients, surgeries involving free flap procedures are highly invasive and pose risks. Thus, we believe that PAT grafting and Integra, for which engraftment is achieved with the blood supply received through wide contact with the healthy tissue surrounding the wound, is a useful option for refractory ulcers as it is a minimally invasive method that causes little postoperative pain. [ABSTRACT FROM AUTHOR]

Joint exposure with an extensive skin defect following soft tissue tumor resection might cause a refractory ulcer. Although a vascularized tissue transplant is ideal for ulcer treatment, it is a highly invasive procedure and usually unsuitable for older patients with general prostration. One-stage perifascial areolar tissue (PAT) and skin grafting combined with negative pressure wound therapy (NPWT) is less invasive and effective procedure for refractory wounds with exposed bones and tendons. This is the first case where this procedure was used to treat a wound that involved an exposed elbow joint with an extensive skin defect. An 80-year-old woman underwent wide excision to remove a leiomyosarcoma on the olecranon with reconstruction using an ipsilateral pedicled latissimus dorsi musculocutaneous flap. The distal three-quarter of the flap was necrosed owing to insufficient blood supply. Furthermore, an articular capsule deficit of 1.5 × 1.0 cm2 was found during necrotomy. The PAT was harvested from the lower abdomen as a non-vascularized tissue, and the articular capsule deficit was covered by overlapping on the granulation tissue around the deficit. Simultaneous split-thickness skin grafting combined with NPWT was applied on the PAT and residual skin defect. Wound healing was achieved in 4 weeks postoperatively without synovial fluid leakage. Elbow joint motion ranging from 0 to 120° was maintained 18 months postoperatively. This procedure helped achieve better wound healing and sufficient functional outcome. Furthermore, this can help decrease patients' burden by preventing invasive resections associated with severe functional impairments or long-term rehabilitation requirements. [ABSTRACT FROM AUTHOR]

Background  Perifascial areolar tissue (PAT) transplant is a method of transplanting loose connective tissue harvested in a sheet form from above the fascia to the wound bed and is effective for wounds with exposed ischemic tissue. However, the engraftment mechanism is unknown, and no animal models of PAT transplant for wound healing exist. Methods  In this study, we harvested connective tissue from the backs of Wistar rats in a sheet form to simulate a human PAT transplant. The PAT was affixed to exposed bone of the head. Results  In the PAT(+) group, the wound areas gradually decreased due to epithelialization and contraction. The wound area of the PAT(+) group was significantly smaller than that of the PAT(−) group. Conclusions  This clinically relevant rat model is useful for elucidating the mechanism of the PAT transplant and establishing a reliable surgical method. [ABSTRACT FROM AUTHOR]

Complete syndactyly with bone fusion in patients with Apert syndrome was treated using perifascial areolar tissue (PAT) grafts via a two-stage surgery (i.e. bone separation using inter-bone PAT graft insertion followed by web separation and reconstruction with full-thickness skin grafts). This technique is easy and created nail folds for fingertips. [ABSTRACT FROM AUTHOR]