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Background Perifascial areolar tissue (PAT) transplant is a technique in which a sheet of connective tissue on the fascia is harvested and transplanted to the wound bed. PAT engraftment fails when the exposed area of tendons, bones, or artificial materials is large. On the other hand, combination of tissue transplant and basic fibroblast growth factor (bFGF) improves the survival rate of the transplanted tissue. Materials and Methods A wound model was created in which the artificial material was exposed on rats' backs. All the rats underwent PAT transplant, but the rats were divided into two groups according to the PAT processing method beforehand. In one group, the PAT was immersed in water for injection before transplant (bFGF[–] group), and in the other group, the PAT was immersed in bFGF product (bFGF[+] group). Specimens were collected 7 days after surgery to assess the histologic thickness of the PAT and the gene expression in the PAT. Results The thickness of the PAT in the tissue slices was significantly higher in the bFGF(+) group than in the bFGF(–) group. Expressions of CD34 and COL3A1 were significantly higher in the bFGF(+) group than in the bFGF(–) group. Conclusion The results of this study indicate that adding bFGF to the PAT transplant may promote PAT engraftment and wound healing by increasing angiogenesis and may increase granulation formation, which may result in a stronger covering that prevents the prosthesis from being exposed. [ABSTRACT FROM AUTHOR]

Background Perifascial areolar tissue (PAT) is an areolar layer over the muscle fascia. PAT has been shown to be resistant to ischemia and prone to survival even in ischemic conditions. PAT grafts provide a vascular tissue layer on necrotic bone and tendons where skin grafting is not possible. The effect of PAT grafting on burn reconstruction has not yet been reported. Thus, in this study, we aimed to present our experience and discuss the role of PAT grafting in extremity burn reconstruction. Methods Between January 2019 and December 2020, 16 PAT grafting procedures were performed in 11 patients. All patients had second- or third-degree burns in the upper and lower extremities, with exposed bone or tendon. PAT grafts were harvested from the abdominal region and were used for the upper extremity in 7 patients and the lower extremity in 4 patients. Immediate skin grafting was performed during the same session. Results The patients’ mean age was 50.7 years; defect size, 3.3 × 3 cm2; and follow-up time, 11.8 months. The survival rates of the PAT and skin grafts were 93.8% and 68.6%, respectively. Partial skin graft losses were encountered in 4 patients, and total skin graft loss was seen in 1 patient. Conclusion PAT grafting is an alternative method to the use of dermal substitutes and flap surgery in small-to-medium-sized defects with exposed bone and tendon in burn patients.

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.

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]

Perifascial areolar tissue (PAT) is an areolar layer over the muscle fascia. PAT has been shown to be resistant to ischemia and prone to survival even in ischemic conditions. PAT grafts provide a vascular tissue layer on necrotic bone and tendons where skin grafting is not possible. The effect of PAT grafting on burn reconstruction has not yet been reported. Thus, in this study, we aimed to present our experience and discuss the role of PAT grafting in extremity burn reconstruction. Between January 2019 and December 2020, 16 PAT grafting procedures were performed in 11 patients. All patients had second- or third-degree burns in the upper and lower extremities, with exposed bone or tendon. PAT grafts were harvested from the abdominal region and were used for the upper extremity in 7 patients and the lower extremity in 4 patients. Immediate skin grafting was performed during the same session. The patients' mean age was 50.7 years; defect size, 3.3 × 3 cm2; and follow-up time, 11.8 months. The survival rates of the PAT and skin grafts were 93.8% and 68.6%, respectively. Partial skin graft losses were encountered in 4 patients, and total skin graft loss was seen in 1 patient. PAT grafting is an alternative method to the use of dermal substitutes and flap surgery in small-to-medium-sized defects with exposed bone and tendon in burn patients. [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]

Summary Soft tissue defects or skin ulcers associated with tendon or bone exposure located distally on the extremities are always difficult to treat. The introduction of the vacuum-assisted closure (VAC) and dermal templates has led to major changes in ulcer treatment strategies. However, it is necessary to find an alternative method to treat these defects when VAC is not available. Perifascial areolar tissue (PAT) is the loose connective tissue on the deep fascia that could be a candidate for repairing soft tissue defects or skin ulcers. Grafting PAT on the exposed bone or tendon, including a wide coverage of well-vascularized tissue surrounding the granulation tissue, can prepare the wound to be subsequently closed by a skin graft. In this study, the PAT was used in various situations and its optimal usage and outcomes were evaluated. A total of 13 PAT grafts were performed and were especially useful for covering narrow ulcers with narrow tendon exposure and filling fistula areas. In comparison to other cases, covering the exposed cortical bone ulcers seemed to be more difficult to perform. However, an option for these ulcers could be the exposure of bone marrow and usage of intraosseous blood flow. It was also possible for the simultaneous engraftment of PAT and skin in narrow areas and could be an alternative in cases of small concave ulcers or fistulae. The PAT graft is a simple and minimally invasive procedure that can be a good alternative when VAC is not available. [ABSTRACT FROM AUTHOR]

Summary Local flaps and composite grafting are the procedures of choice for reconstructing relatively small soft tissue defects. However, despite their limited conveyable volume, local flaps sometimes require a wide dissection area and long new incisions. Composite grafts also have serious limitations and require a well-vascularized recipient bed. To overcome these limitations, we used a free vascularized perivascular tissue flap based on the descending branch of the lateral femoral circumflex artery. Using this method, we performed reconstructions for seven patients (four cases in head and neck region and three cases in lower limb) with various soft tissue defects (ranged from 4.0 cm 3 to 40.0 cm 3 ). This flap was easily elevated, without the need for precise preoperative flap design, and the flap volume was adjustable regardless of whether deep fascia and muscle were included. The flap has a rich vascular supply, which allows bone and cartilage tissue to be combined with the transfer of soft tissue, and satisfactorily treats chronic wounds with poor blood supply. [ABSTRACT FROM AUTHOR]

Objectives Perifascial areolar tissue (PAT), a layer of loose connective tissue on the deep fascias with a rich vascular plexus, serves as a vital cover over defects with scarce vascularity. We report the usefulness of PAT as a nonvascularized alternative to flaps for reconstruction of dural defects in skull base surgery and transsphenoidal surgery while evaluating its effect on control of cerebrospinal fluid (CSF) leakage. Design A retrospective chart analysis was performed on patients who had undergone repair of a dural defect with PAT during skull base surgery or transsphenoidal surgery between December 2004 and October 2011. Results Twenty-one patients were included: 11 patients had received surgical treatment and/or irradiation. Fourteen of the 21 patients had pre- and/or intraoperative CSF leakage. Only one patient (4.8%) had postoperative CSF leakage requiring additional surgical repair. Ten patients underwent postoperative irradiation from 1 to 15 months after transplant of the PAT. None of the patients had postoperative CSF leakage after irradiation. Conclusion We successfully repaired dural defects using PAT in skull base surgery and transsphenoidal surgery, even in patients with a history of multiple operations and radiotherapy. PAT may serve as a valuable tool for skull base reconstruction. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of adhesiotomy with grafting of fat and perifascial areolar tissue (A-GFPAT) on eyes with restricted eye movements after trauma or surgery. Design: Single-center retrospective interventional, consecutive case series. Methods: Twenty-four eyes of 24 patients that underwent A-GFPAT were studied. The changes in the eye movements was evaluated by the Hess area ratio (HAR %) and in the binocular single vision (BSV) field scores. Results: The HAR % was significantly improved by the A-GFPAT, from 50.9 ± 32.0 % (±SD) to 66.4 ± 28.2 % at the final visit (Student's t test; P < 0.01). Nine of the 24 cases (37.5 %) had an improvement of the final HAR % by >10 %. The preoperative mean BSV field score was 15.4 ± 13.3, which improved significantly to 25.9 ± 10.5 after the A-GFPAT ( P < 0.001). Thirteen cases (56.5 %) had an improvement of the final BSV score by more than 5 points. There were improvements of both HAR % (50 %) and BSV score (54.5 %) by more than 50 % after A-GFPAT in patients with old orbital fractures. All patients who had been treated with Lactosorb® earlier had an improvement of the BSV score, while those treated with endoscopic transmaxillary reduction and balloon technique had a lower chance of improvement (20 %). Conclusions: Our new technique of A-GFPAT leads to improvements of eye movements that had been limited by the adhesion of orbital soft tissue and periorbita with less adverse effects. We recommend our surgical procedure for eyes with restrictive eye movements or pain caused by adhesions following trauma or ocular surgery. [ABSTRACT FROM AUTHOR]

Reconstruction using flaps with good blood circulation is appropriate for covering an intractable ulcer or a fistula in which tendon or bones are exposed. A non-vascularised perifascial areolar tissue (PAT) graft can also survive in such an area. This study reports the versatile application of a PAT graft for use as a non-vascularised graft material. A total of 32 patients were treated between April 2004 and December 2010 (16 men and 16 women). The donor sites were the inguinal region in 20, the thigh in 11, and the subclavian region in one. There were 13 inlay grafts to the dead space after tumour resection, eight closures for cerebrospinal fluid leakage, seven skin ulcers with exposed bones and tendons, three fistulas, and one vascular leak of the common carotid artery. The total survival rate of the grafts was 91%. The complications associated with this procedure included infection in 9% and seroma in the donor site in 19%. However, all cases improved after conservative treatment. The PAT is a pliable loose areolar tissue with a rich vascular plexus, and the harvesting technique is quite simple and minimally invasive. The PAT graft could therefore represent an alternative for flaps that are used as a free graft material for the reconstruction of such defects as intractable skin ulcers, fistulas or dead spaces that usually require reconstruction with vascularised flaps. [ABSTRACT FROM AUTHOR]