Thin Anterolateral Thigh Perforator Flaps Using Modified Perforator Microdissection and Clinical Application for Foot Resurfacing

A thin flap is often required for optimal resurfacing of particular areas of the body. The anterolateral thigh (ALT) perforator flap can be thinned to an extent which is vascularized by the subdermal plexus only. The authors presented their flap-thinning technique and its application for resurfacing of dorsal feet.

From July 2002 to October 2003, 18 patients underwent dorsal foot resurfacing with thin anterolateral thigh flaps. The main perforators were strategically located in the flap to keep the peripheral area within vascular territory. The flaps were designed larger than needed, and were initially elevated subfacially, and then were thinned to a suitable thickness, while the pedicles still remained attached. The dissection of perforators in the adipose layer close to entry to the dermis was carried out under the microscope. The flap sizes ranged from 3 × 3 to 16 × 8 cm.

Seventeen flaps had complete survival. One had distal superficial necrosis of a 1- × 2-cm area. At an average of 12 months follow-up, no debulking procedures were necessary.

Thin flap vascularization through the subdermal plexus is reliable and microsurgical dissection of the perforator is a good technique. In dorsal foot resurfacing, the thin ALT perforator flap provides an ideal reconstruction.