Application of layered harvesting technique for thin anterolateral thigh flap based on preoperative perfora-tor mapping by CDU and DSA
Objective To evaluate the application of layered harvesting technique for thin anterolateral thigh flap(ALTF)based on preoperative perforator mapping by colour Doppler ultrasound(CDU)and digital subtrac-tion angiography(DSA).Methods From April 2023 to November 2023,13 patients(14 flaps)with forearm and hand wounds.were treated in the Department of Hand Surgery,Beijing Jishuitan Hospital,Capital Medical University,In this study,they were 8 males and 5 females;aged from 19 to 58 years old,with a mean of 37 years old.Body Mass Index(BMI)was 17.30-31.87 kg/m2 with an average of 23.64 kg/m2.The flap area was 9 cm×6 cm-20 cm× 13 cm;the flap thickness was 4-6 mm with an average of 5.2 mm.Before surgery,CDU was applied to determine the entrance of the perforator vessel and made skin marking.DSA technology was further used to relocate the posi-tion of the perforator vessel and the branches of the superficial fascia layer at the flap tangential position.Based on the precise perforator positioning,the thin ALTF was harvested between the deep and superficial layers of the superficial fascia.Regular outpatient follow-ups were conducted after surgery.Results The 14 flaps had 1 to 2 perforators and 2 to 4 superficial fascia branches,and the preoperative positioning coincided with the intraoperative perforator entrance,and the distance was less than 1 cm.All patients were included in the follow-up from 1 to 7 months with a mean of 3.2 months.Only 1 patient had the complication delayed healing at the donor site.All flaps survived successfully and had a good appearance without secondary trimming.Conclusion Preoperative CDU and DSA accurately locate the entrance of the perforator and the distribution of superficial fascial branches,and the layered harvesting technique for thin ALTF,effectively reduces the difficulty at harvesting of the thin flap and reduces damage to the donor site.
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