Alternative Design for Anterolateral Thigh Multi-Paddled Flaps: The 3-5 System

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Surgical Anatomy

Background:

• Anterolateral thigh (ALT) multi-paddled flap design is crucial for reconstructive surgeries.
• Traditional ALT flap design methods face limitations due to variable perforator distribution.
• Accurate perforator localization is essential for successful flap harvest.

Purpose of the Study:

• To evaluate the efficacy of a novel "3-5 system" for designing ALT multi-paddled flaps.
• To determine if the 3-5 system can eliminate the need for preoperative handheld Doppler.
• To establish a standardized and practical approach for ALT flap design.

Main Methods:

• Harvested 151 ALT flaps from 149 patients over 26 months.
• Utilized handheld Doppler to map perforators in 100 flaps preoperatively.
• Developed and applied the 3-5 system for flap design based on perforator anatomy.

Main Results:

• Identified precise perforator distribution patterns through the vastus lateralis muscle (VLM) and deep fascia.
• The 3-5 system, based on 3 longitudinal and 5 horizontal lines, accurately predicted perforator entry points.
• Successfully harvested 51 ALT flaps using the 3-5 system without preoperative Doppler, demonstrating its practicality.

Conclusions:

• The 3-5 system provides a simple and effective method for preoperative ALT multi-paddled flap design.
• This novel system enhances surgical planning and reduces reliance on preoperative imaging.
• The 3-5 system facilitates successful ALT flap harvest in reconstructive procedures.