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CC BY-NC 4.0 · Arch Plast Surg 2021; 48(01): 121-126
DOI: 10.5999/aps.2020.01802
Extremity/Lymphedema
Original Article

The perforator-centralizing technique for super-thin anterolateral thigh perforator flaps: Minimizing the partial necrosis rate

Young Chul Suh 
Department of Plastic and Reconstructive Surgery, Bucheon St. Mary Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
,
Na Rim Kim 
Department of Plastic and Reconstructive Surgery, Bucheon St. Mary Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
,
Dai Won Jun 
Department of Plastic and Reconstructive Surgery, Bucheon St. Mary Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
,
Jung Ho Lee 
Department of Plastic and Reconstructive Surgery, Bucheon St. Mary Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
,
Young Jin Kim 
Department of Plastic and Reconstructive Surgery, Bucheon St. Mary Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Background Despite the wide demand for thin flaps for various types of extremity reconstruction, the thin elevation technique for anterolateral thigh (ALT) flaps is not very popular because of its technical difficulty and safety concerns. This study proposes a novel perforatorcentralizing technique for super-thin ALT flaps and analyzes its effects in comparison with a skewed-perforator group.

Methods From June 2018 to January 2020, 41 patients who required coverage of various types of defects with a single perforator-based super-thin ALT free flap were enrolled. The incidence of partial necrosis and proportion of the necrotic area were analyzed on postoperative day 20 according to the location of superficial penetrating perforators along the flap. The centralized-perforator group was defined as having a perforator anchored to the middle third of the x- and y-axes of the flap, while the skewed-perforator group was defined as having a perforator anchored outside of the middle third of the x- and y-axes of the flap.

Results No statistically significant difference in flap thickness and dimension was found between the two groups. The arterial and venous anastomosis patterns of patients in both groups were not significantly different. Only the mean partial necrotic area showed a statistically significant difference between the two groups (centralized-perforator group, 3.4%±2.2%; skewed-perforator group, 15.8%±8.6%; P=0.022).

Conclusions The present study demonstrated that super-thin ALT perforator flaps can be elevated safely, with minimal partial necrosis, using the perforator-centralizing technique.

Keywords

Free flaps - Perforator flaps - Microsurgical free flaps

Part of this article was presented at the 10th Congress of the World Society for Reconstructive Microsurgery on June 12-15, 2019, in Bologna, Italy.




Publication History

Received: 13 September 2020

Accepted: 17 November 2020

Article published online:
20 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • REFERENCES

  • 1 Seth AK, Iorio ML. Super-thin and suprafascial anterolateral thigh perforator flaps for extremity reconstruction. J Reconstr Microsurg 2017; 33: 466-73
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Schaverien M, Saint-Cyr M, Arbique G. et al. Three- and four-dimensional computed tomographic angiography and venography of the anterolateral thigh perforator flap. Plast Reconstr Surg 2008; 121: 1685-96
    CrossrefPubMedGoogle Scholar
  • 3 Nakajima H, Minabe T, Imanishi N. Three-dimensional analysis and classification of arteries in the skin and subcutaneous adipofascial tissue by computer graphics imaging. Plast Reconstr Surg 1998; 102: 748-60
    CrossrefPubMedGoogle Scholar
  • 4 Kim YH, Lee HE, Lee JH. et al. Reliability of eccentric position of the pedicle instead of central position in a thoracodorsal artery perforator flap. Microsurgery 2017; 37: 44-8
    CrossrefPubMedGoogle Scholar
  • 5 Hong JP, Choi DH, Suh H. et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014; 30: 491-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Kim SY, Lee YJ, Mun GH. Anatomical understanding of target subcutaneous tissue layer for thinning procedures in thoracodorsal artery perforator, superficial circumflex iliac artery perforator, and anterolateral thigh perforator flaps. Plast Reconstr Surg 2018; 142: 521-34
    CrossrefPubMedGoogle Scholar
  • 7 Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap thinning: techniques and complications. Ann Plast Surg 2014; 72: 246-52
    CrossrefPubMedGoogle Scholar
  • 8 Ulas Bali Z, Kececi Y, Pabuscu Y. et al. Anterolateral thigh flap design by using suprafascial course of the perforator. Ann Plast Surg 2020; 84: 550-3
    CrossrefPubMedGoogle Scholar
  • 9 Kimura N, Satoh K, Hasumi T. et al. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg 2001; 108: 1197-208
    CrossrefPubMedGoogle Scholar
  • 10 Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator flaps: 46 cases. Plast Reconstr Surg 2003; 112: 1875-85
    CrossrefPubMedGoogle Scholar