Anatomical Understanding of Target Subcutaneous Tissue Layer for Thinning Procedures in TDAP, SCIP and ALT Perforator Flaps

Background: Thinned perforator flaps, reported techniques and degree of thinning differ by study. This study investigated the anatomy of subcutaneous tissue according to the varying fattiness and identified which component and how much of the subcutaneous tissue layer needed to be excluded to meet target flap thickness using computed tomography(CT). Methods: Three stratified fattiness groups consisting of 30 donors were made for TDAP, SCIP and ALT flaps. The thickness of the superficial fat layer (SFL) and the deep fat layer (DFL) were measured at 3 points in TDAP, 2 points in SCIP and 3 points in ALT flaps, and the proportion of SFL and DFL to exclude to reach target flap thickness (4, 6, and 8mm) was calculated. Result: The median proportion for SFL ranged from 54.8% to 75.2% for TDAP, 62.1% to 72.7% for SCIP and 48.7% to 69.1% for ALT depending on donor fattiness. The estimated % reduction of thickness after thin flap elevation along superficial fascia was approximately one third of the whole layer. A variable proportion of SFL and DFL needs to be excluded to obtain required thinness and in very thick groups, part of the SFL must be removed to reach any of the target thicknesses for three flaps. Conclusion: The present study demonstrated the frequent need for SFL manipulation when obtaining a thin perforator flap. To cope with various combinations of donor site fattiness and different required thicknesses effectively, an appropriate thinning method should have increased adaptability, including the ability to control SFL thickness. Financial Disclosure: None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding Author Contact Information: Dr. Goo-Hyun Mun, M.D., Ph.D. Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, S. Korea, 06351 Tel.: 82-2-3410-2233/Fax: 82-2-3410-0036/E-mail: supramicro@gmail.com ©2018American Society of Plastic Surgeons

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