From the Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine.
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Plast Reconstr Surg. 2023 Oct 1;152(4):718e-723e. doi: 10.1097/PRS.0000000000010295. Epub 2023 Feb 14.
Although many efforts have been made to create thinner anterolateral thigh (ALT) flaps, their thickness varies among patients, and the flap may be still too thick to match shallow defects. The authors successfully harvested an ALT flap through the most superficial elevation plane, the superficial fat layer, which was useful to match the shallow defects.
All patients who underwent ALT free flap reconstruction for upper and lower distal extremity defects were divided retrospectively into groups by ALT flap elevation plane: thin, above the deep fascia; superthin, at the superficial fascia; and ultrathin, through the superficial fat. Preoperative computed tomographic angiography and duplex ultrasonography planning were used for all patients. Anatomical characteristics of donor subcutaneous tissue and surgical details, including flap thickness, flap size, and incidence of flap necrosis were compared among the groups and between sexes.
The average deep and superficial fascial depths were 16.7 and 10.8 mm, 12.5 and 8.2 mm, and 9.1 and 5.6 mm ( P < 0.05), and the average flap thickness was 5.8 mm, 7.9 mm, and 7.8 mm ( P = 0.29) in the ultrathin, superthin, and thin ALT groups, respectively. No significant intergroup differences existed in flap size or complications. The deep and superficial fascia were located significantly deeper in female patients (9.4 and 6.0 mm in male patients and 14.9 and 9.6 mm in female patients, respectively).
With precise preoperative planning, the most superficially elevated, ultrathin ALT flap can achieve optimal reconstructions of thin body areas. Female patients with thicker thighs and patients with a high body mass index would benefit from this flap.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
尽管已经做出了许多努力来制造更薄的前外侧大腿（ALT）皮瓣，但它们在患者之间的厚度存在差异，而且皮瓣仍然可能太厚，无法匹配浅层缺损。作者通过最浅表的抬高平面，即浅脂肪层，成功地采集了 ALT 皮瓣，这对于匹配浅层缺损非常有用。
回顾性地将所有接受过用于上下远端肢体缺损的 ALT 游离皮瓣重建的患者，根据 ALT 皮瓣抬高平面分组：薄型，在深筋膜上方；超薄型，在浅筋膜；超薄型，通过浅脂肪层。所有患者均进行术前 CT 血管造影和双功超声检查计划。比较各组和性别之间供区皮下组织的解剖学特征和手术细节，包括皮瓣厚度、皮瓣大小和皮瓣坏死发生率。
平均深筋膜和浅筋膜的深度分别为 16.7 和 10.8mm、12.5 和 8.2mm、9.1 和 5.6mm（P <0.05），超薄、超薄和薄型 ALT 组的平均皮瓣厚度分别为 5.8mm、7.9mm 和 7.8mm（P = 0.29）。皮瓣大小或并发症在组间无显著差异。女性患者的深筋膜和浅筋膜明显更深（男性患者为 9.4 和 6.0mm，女性患者为 14.9 和 9.6mm）。
通过精确的术前规划，可以对最浅表抬高的超薄 ALT 皮瓣进行优化重建，适用于较薄的身体区域。大腿较厚的女性患者和 BMI 较高的患者将受益于这种皮瓣。
临床问题/证据水平：治疗性，IV。
