Introducing the subdermal free flap: Preserving the ultrathin-free skin flap option in morbidly obese patients

Why this matters

In the morbidly obese population (BMI > 35), distal extremity defects are difficult to reconstruct. This work contributes to evidence-based plastic and reconstructive surgery — helping clinicians interpret outcomes, refine technique, and counsel patients with clearer data.

Author

Dr. Orr Shauly

Plastic and reconstructive surgery resident at Emory University (UCLA BS, USC MD) with an h-index of 21 and peer-reviewed work spanning aesthetic surgery, reconstruction, medical devices, and AI in medicine.

Abstract

In the morbidly obese population (BMI > 35), distal extremity defects are difficult to reconstruct. Traditional skin flaps are several centimeters in thickness in obese patients; however, a new plane superficial to the scarpal plane has demonstrated success in these patients. In this report, we present a 62-year-old female (BMI = 44.81) with a chronic lower extremity wound. A suprascarpal thin flap (approximately 1 cm in thickness) was harvested from the thigh and transferred successfully with no wound-healing issues.