Fig. 2

Intraoperative findings. Upon discarding the distal part of zone 4, Scarpa’s fascia and the superficial fat tissue in the proximal part of zone 4 are entirely removed, leaving only the dermal tissue. Thus, the proximal part of zone 4 is formed into a vascularized dermis graft. The upper and lower portions of the distal 80 % of zone 2 are used to form a dermofat flap (including the dermis and thin superficial fat tissue) by removing Scarpa’s fascia and part of the superficial fat tissue. The middle portion of the distal 80 % of zone 2 is used to form a dermo-adipofascial flap (including the dermis and thick superficial fat tissue, and retaining Scarpa’s fascia)