Simultaneous flap thinning with ultrasound-assisted liposuction during free flap surgery: Preliminary results

Ultrasound-assisted liposuction (UAL) has been previously used for postoperative flap thinning. Although it had been reported that UAL causes less damage to the vessels, the simultaneous use of UAL with free flap reconstruction has not been reported. The aim of this report was to determine the results and the complication rates of simultaneous use of UAL with free flap reconstruction.

Twelve patients who underwent simultaneous flap thinning with UAL during free anterolateral thigh flap surgery between 2014 and 2016 were included in this prospective study. The mean age of the patients was 46.7 (ranging 10-76) years. The mean body mass index of the patients was 26.81 (ranging 25.2-29.8). Flaps were thinned with UAL before harvesting. The mean flap thicknesses were measured using a metal ruler before and after the UAL procedure. Biopsies were performed lateral to the center of the flaps, after completion of the UAL procedure. Vascular and collagen structures were histopathologically examined. The Likert scale, which evaluates the general appearance, shape, color, and texture, was used to assess the aesthetic results of the UAL procedure.

The average flap size was 13 × 9 cm. The mean pedicle length was 8.3 (ranging 7-10) cm. The mean flap thickness was 23 (ranging 19-27) mm and decreased to a mean of 8.1 (ranging 5-11) mm. Wound dehiscence and partial skin necrosis was observed in 2 patients (2/12, 16.66%). None of the patients had total flap necrosis. Vascular and collagen structures of the biopsied samples were normal. Patients were followed for an average of 13 months post UAL. The mean Likert score was 17.1 (ranging 15-19).

Flap thinning with UAL can be safely performed during the initial free flap reconstruction operation.