Reliability and Safety of the Superthin Anterolateral Thigh Flap: Evaluating Perfusion-Related Complications and Donor Morbidity.

BACKGROUND

With an increasing need for thin flaps, the use of superthin anterolateral thigh (ALT) flaps, raised above the supra-superficial fascia, has drawn great attention. Controversy remains regarding whether such thin-flap elevation could affect postoperative outcomes, encompassing perfusion-related complications (PRCs) and donor-site morbidity. This study aimed to evaluate the outcomes of superthin ALT flap-based reconstruction compared with those of suprafascially elevated flaps.

METHODS

Patients who underwent free ALT flap-based reconstruction between March of 2017 and June of 2023 were reviewed and categorized into 2 groups based on flap elevation plane: superthin or suprafascial. Development of PRC and donor-site morbidity, including paresthesia, was compared. Independent associations of the elevation plane with complication profiles were evaluated. Further analyses were conducted using propensity score matching.

RESULTS

In total, 208 cases were analyzed: 80 superthin and 128 suprafascial ALT flaps. Nineteen cases (9.1%) experienced PRC, including 4 total and 14 partial necrosis. The incidence of overall and each type of PRC did not differ based on flap elevation plane even after adjusting for other variables. The superthin group exhibited significantly lower donor-site complications compared with the others, which was upheld in multivariable analyses. Elevating the flaps in a superthin fashion allowed for a higher rate of preservation of the lateral femoral cutaneous nerve, resulting in a significantly lower rate of postoperative paresthesia. Similar associations were observed in the propensity score matching analysis.

CONCLUSION

Superthin ALT flap elevation does not appear to increase PRC risk and reduces donor-site complications, compared with suprafascial elevation.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.