Practical Considerations for Perforator Flap Thinning Procedures Revisited

Background A thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques.

Methods We performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution. The second study was done on four cadavers independently from the first study. Last, a clinical series was performed on 15 patients.

Results The areolar fat lobules of 10 anterolateral thigh perforator (ALT), seven deep inferior epigastric artery perforator (DIEAP), and six thoracodorsal artery perforator (TAP) flaps were dissected to reduce the flap thickness guided by the colored vascular pattern. On average, the ALT, DIEAP, and TAP flaps were reduced to 32.76%±9.76%, 37.01%±9.21%, and 35.42%±9.41%, respectively. In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of 53.41%±5.64%, 52.30%±2.88%, and 47.87%±6.41%, respectively, was found. In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of 37.91%±7.15%.

Conclusions These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap. This evidence suggests that the macroscopic flap thinning technique can achieve thin flaps. Surgeons should consider this technique before embracing the latest technique of supermicrosurgery.

Keywords

Microsurgery - Microvessels - Perforator flap - Subcutaneous fat - Surgical flaps

Part of this study was presented in the 14th Association of Southeast Asian Nations (ASEAN) Congress of Plastic Surgery (ACPS) in conjunction with 12th Annual Scientific Meeting of the Indonesian Association of Plastic Surgeons, Jakarta, Indonesia (May 9-11, 2008); the 15th World Congress of International Confederation for Plastic, Reconstructive and Aesthetic Surgery (IPRAS), New Delhi, India (November 29-December 3, 2009); and at the 11th Triennial Congress of International Federation of Society for Surgery of the Hand (IFSSH), Seoul, Republic of Korea (November 31-December 4, 2010).

Publikationsverlauf

Eingereicht: 27. Juni 2014

Angenommen: 04. August 2014

Artikel online veröffentlicht:
05. Mai 2022

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