Fasciocutaneous Flap Reconstruction of the Inguinal Region: A Contemporary Review of Anatomy, Indications and Technique

Abstract

Reconstruction of the inguinal region remains one of the most demanding problems in reconstructive plastic surgery. Defects in this area arise after vascular reconstruction, oncological lymphadenectomy, necrotizing soft-tissue infection, burns, radiotherapy and trauma, and they frequently expose femoral vessels or prosthetic grafts in a contaminated, mobile and lymphatic-rich field. Muscle and musculocutaneous flaps have historically been considered the standard of care, largely on the basis of experimental work suggesting superior bacterial clearance. Over the last four decades, however, the fasciocutaneous flap has evolved from the empirical "superflap" concept into a family of well-characterized axial, septocutaneous and perforator-based reconstructions, including the medial thigh fasciocutaneous flap, the island groin flap based on the superficial circumflex iliac artery, the superficial circumflex iliac artery perforator flap, and the pedicled anterolateral thigh flap in its fasciocutaneous and chimeric forms. This narrative review summarizes the vascular anatomy that underpins these flaps, the etiology and assessment of inguinal defects, the technical steps and pitfalls of the principal fasciocutaneous options, and the published outcomes of both muscle and fasciocutaneous reconstruction. Current evidence, although retrospective and heterogeneous, indicates that graft and limb salvage rates are comparable between flap classes, and that flap selection should be driven by dead-space volume, quality and quantity of the skin deficit, integrity of the donor pedicle in patients with peripheral arterial disease, and functional donor-site considerations rather than by category alone. A practical, defect-oriented reconstructive algorithm is proposed.