The use of a honeycomb technique combined with ultrasonic aspirators and indocyanine green fluorescence angiography for a superthin anterolateral thigh flap: a pilot study

Background: Harvesting an optimally thinned anterolateral thigh flaps (ALTFs) is a challenge in overweight individuals and in the Western population. Here, we describe a novel honeycomb technique to achieve a superthin ALTF in overweight patients. Methods: Forty patients with a body mass index(BMI) >25 kg/m2 who required a thinned ALTF for reconstruction were randomly assigned to a honeycomb technique (HCT) group or a microdissection technique (MDT) group. Patients in the HCT group received cavitron ultrasonic surgical aspiration (CUSA) to thin the flaps, and flap thinning was performed with a conventional MDT in the MDT group. The perfusion of all flaps was measured by indocyanine green fluorescence (ICG) angiography before and after thinning. Hypoperfusion was defined as 30 percent. Results: The mean BMI was 28.6±2.0 and 27.3±1.9 in the HCT group and the MDT group, respectively. The flap size, perforator, type of dissection and the initial perfusion were comparable between the two groups. However, significantly more patients (9/21) experienced final hypoperfusion in the MDT group than in the HCT group (2/19) (p=0.034). In addition, blood loss and final flap thickness were significantly lower in the HCT group (p