Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2018; 45(04): 304-313
DOI: 10.5999/aps.2017.01529
Topic: how to obtain thin flap

Thin elevation: A technique for achieving thin perforator flaps

Hyung Hwa Jeong
Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Joon Pio Hong
Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Hyun Suk Suh
Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
› Author Affiliations
› Further Information
   Permissions and Reprints

Elevating thin flaps has long been a goal of reconstructive surgeons. Thin flaps have numerous advantages in reconstruction. In this study, we present a surgical method for elevating a thin flap and demonstrate the safety of the procedure. A retrospective review was performed of the electronic medical records of patients who underwent thin flap elevation for lower extremity reconstruction from April 2016 to September 2016 at the Department of Plastic Surgery of Asan Medical Center. All flaps included in this study were elevated above the superficial fascia. A total of 15 superficial circumflex iliac artery free flaps and 13 anterolateral thigh free flaps were enrolled in the study. The total complication rate was 17.56% (n=5), with total loss of the flap in one patient (3.57%) and partial necrosis of the flap in four patients (14.28%). No wound dehiscence or graft loss at the donor wound took place. Elevation above the superficial fascia is not inferior in terms of flap necrosis risk and is superior for reducing donor site morbidity. In addition to its safety, it yields good aesthetic results.

Keywords

Lower extremity - Free tissue flaps - Subcutaneous tissue


Publication History

Received: 19 July 2017

Accepted: 26 June 2018

Article published online:
03 April 2022

© 2018. 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/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • REFERENCES

  • 1 Garg RK, Poore SO, Wieland AM. et al. Elective free flap revision in the head and neck cancer patient: indications and outcomes. Microsurgery 2015; 35: 591-5
    CrossrefPubMedGoogle Scholar
  • 2 Celik N, Wei FC, Lin CH. et al. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg 2002; 109: 2211-6
    CrossrefPubMedGoogle Scholar
  • 3 Hong JP, Sun SH, Ben-Nakhi M. Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects. Ann Plast Surg 2013; 71: 380-3
    CrossrefPubMedGoogle Scholar
  • 4 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
  • 5 Lee MG, Kim JS, Lee DC. et al. Fascial free flap for reconstruction of the dorsolateral hand and digits: the advantage of a thin contour. Arch Plast Surg 2016; 43: 551-8
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Baujat B, Struk S, Lesnik M. et al. Fascia temporalis free flap for cricotracheal reconstruction: a novel approach. Ann Thorac Surg 2017; 104: 1040-6
    CrossrefPubMedGoogle Scholar
  • 7 Lee KT, Park SJ, Mun GH. Reconstruction outcomes of oncologic foot defect using well-contoured free perforator flaps. Ann Surg Oncol 2017; 24: 2404-12
    CrossrefPubMedGoogle Scholar
  • 8 Kuran I, Turgut G, Bas L. et al. Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area. Plast Reconstr Surg 2000; 105: 574-80
    CrossrefPubMedGoogle Scholar
  • 9 Hollenbeck ST, Woo S, Komatsu I. et al. Longitudinal outcomes and application of the subunit principle to 165 foot and ankle free tissue transfers. Plast Reconstr Surg 2010; 125: 924-34
    CrossrefPubMedGoogle Scholar
  • 10 Choi DH, Goh T, Cho JY. et al. Thin superficial circumflex iliac artery perforator flap and supermicrosurgery technique for face reconstruction. J Craniofac Surg 2014; 25: 2130-3
    CrossrefPubMedGoogle Scholar
  • 11 Clemens MW, Colen LB, Attinger CE. Foot reconstruction. In: Neligan PC, Song DH. Plastic surgery. London: Elsevier Saunders; 2013: 189-218
    Google Scholar
  • 12 Burusapat C, Nanasilp T, Kunaphensaeng P. et al. Effect of atherosclerosis on the lateral circumflex femoral artery and its descending branch: comparative study to nonatherosclerotic risk. Plast Reconstr Surg Glob Open 2016; 4: e856
    CrossrefPubMedGoogle Scholar
  • 13 Saint-Cyr M, Wong C, Schaverien M. et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124: 1529-44
    CrossrefPubMedGoogle Scholar
  • 14 Chen YC, Scaglioni MF, Carrillo Jimenez LE. et al. Suprafascial anterolateral thigh flap harvest: a better way to minimize donor-site morbidity in head and neck reconstruction. Plast Reconstr Surg 2016; 138: 689-98
    CrossrefPubMedGoogle Scholar
  • 15 Hong JP, Chung IW. The superficial fascia as a new plane of elevation for anterolateral thigh flaps. Ann Plast Surg 2013; 70: 192-5
    CrossrefPubMedGoogle Scholar
  • 16 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
  • 17 Khuri SF, Daley J, Henderson W. et al. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997; 185: 315-27
    PubMedGoogle Scholar
  • 18 Devoto G, Gallo F, Marchello C. et al. Prealbumin serum concentrations as a useful tool in the assessment of malnutrition in hospitalized patients. Clin Chem 2006; 52: 2281-5
    CrossrefPubMedGoogle Scholar
  • 19 Suh HS, Oh TS, Lee HS. et al. A new approach for reconstruction of diabetic foot wounds using the angiosome and supermicrosurgery concept. Plast Reconstr Surg 2016; 138: 702e-709e
    CrossrefPubMedGoogle Scholar
  • 20 Wada H, Vargas CR, Angelo J. et al. Accurate prediction of tissue viability at postoperative day 7 using only two intraoperative subsecond near-infrared fluorescence images. Plast Reconstr Surg 2017; 139: 354-63
    CrossrefPubMedGoogle Scholar
  • 21 Sharabi SE, Hatef DA, Koshy JC. et al. Is primary thinning of the anterolateral thigh flap recommended?. Ann Plast Surg 2010; 65: 555-9
    CrossrefPubMedGoogle Scholar
  • 22 Sun G, Lu M, Tang E. et al. Clinical application of free anterolateral thigh flap in the reconstruction of intraoral defects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112: 34-41
    CrossrefPubMedGoogle Scholar
  • 23 Shonka Jr DC, Kohli NV, Milam BM. et al. Suprafascial harvest of the radial forearm free flap decreases the risk of postoperative tendon exposure. Ann Otol Rhinol Laryngol 2017; 126: 224-8
    CrossrefPubMedGoogle Scholar
  • 24 Fischer S, Klinkenberg M, Behr B. et al. Comparison of donor-site morbidity and satisfaction between anterolateral thigh and parascapular free flaps in the same patient. J Reconstr Microsurg 2013; 29: 537-44
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Ribuffo D, Cigna E, Gargano F. et al. The innervated anterolateral thigh flap: anatomical study and clinical implications. Plast Reconstr Surg 2005; 115: 464-70
    CrossrefPubMedGoogle Scholar
  • 26 Ali RS, Bluebond-Langner R, Rodriguez ED. et al. The versatility of the anterolateral thigh flap. Plast Reconstr Surg 2009; 124(6 Suppl): e395-407
    CrossrefPubMedGoogle Scholar
  • 27 Adani R, Tarallo L, Marcoccio I. et al. Hand reconstruction using the thin anterolateral thigh flap. Plast Reconstr Surg 2005; 116: 467-73
    CrossrefPubMedGoogle Scholar