Flap Elevation Research Articles

Smartphone-based thermal imaging for pedicled skin flaps: a pilot study toward objective perfusion assessment in facial, head, and neck reconstruction.

This study aims to develop a practical algorithm for utilizing smartphone-based thermal imaging (SBTI) in the perioperative setting and to establish a standardized evaluation method for objectively assessing SBTI images for cutaneous perfusion of pedicled flaps in the face, head, and neck. This prospective conducted study, integrated SBTI into the assessment of 16 patients undergoing reconstructive surgery for face and neck defects. Thermal images were captured at four timepoints: after marking (T1), after flap elevation (T2), upon completion of surgery (T3), and 24h postoperatively (T4). The flap areas were divided into three flap zones and graded based on temperature differences (ΔT), with a grading system where grade 1 indicated perfect perfusion and grades 2 to 5 indicated increasing perfusion impairment. 6 male and 10 female patients aged 64-93 years (mean 78.5 years) undergoing reconstructive pedicled skin flap surgery for facial and neck defects (1 × 1cm to 11 × 8cm) due to diagnoses of malignant cutaneous lesions were investigated. Intraoperative assessments indicated good perfusion across flaps. One postoperative dehiscence occurred in an 83-year-old male with a cervical advancement flap, correlated with a significant temperature difference (ΔT > 4°C) intraoperatively. Statistical analysis revealed a strong positive correlation (p = 0.0003) between clinical assessment grades and ΔT values between specific flap zones at T3. SBTI is an easy-to-apply, low-cost, real-time and reproducible technique for indirect perfusion assessment in pedicled skin flaps of the head and neck region. Further studies are needed implementing this methodology in large and free flaps.

Animation of latissimus dorsi flap in breast reconstruction: a retrospective analysis based on 203 cases.

Breast animation is a common postoperative complication of breast reconstruction surgery. This study investigates the factors affecting the onset and degree of animation to suggest an ideal treatment strategy for this complication. This study included patients who underwent latissimus dorsi reconstruction at Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, between 2009 and 2020 and had an outpatient visit after July 2020. Statistical analysis was performed and the patients' background and surgical factors were examined to determine whether they affected the animation incidence rate. The animation incidence rate was 69.6%. There was no significant relationship between animation incidence and any patient background or surgical factors, except for the complete dissection of insertion into the humerus of the latissimus dorsi muscle (p = 0.0039). The rate of uncomfortable animation was 4% and recurrence of animation was observed in one of the two patients who underwent denervation. Prophylactic denervation is not considered necessary and should be offered only for persistent discomfort with animation. Instead, the muscle insertion must be dissected during flap elevation to prevent animation, and the thoracodorsal nerve must be preserved to avoid muscle atrophy.

3D-Printable Biopolymers for Socket Preservation Technique: Soft Tissues Response: A Pilot Randomised Clinical Study.

The aim of the present parallel clinical study is to evaluate the efficacy of 3D-printed biopolymers compounded with osteoconductive material (beta-tricalcium phosphate and hydroxyapatite) for soft tissue closure after tooth extraction. this study followed the CONSORT reporting guidelines; 39 patients were treated with socket preservation using 3D-printed biopolymers and randomly divided into 3 groups (Test 1, Test 2, and Control). All cases were treated without flap elevation, careful cleaning and debridement of the sites, and then randomly sealed as follows: In T1, with a 3D-printed disk of poli-D-lactic acid with 10% of hydroxyapatite; in T2, using a 3D-printed disk of poli-ε caprolactone with 20% of β-tricalcium phosphate; and in T3, the socket was left open to heal. At baseline (extraction time) and 6 weeks after extraction, the rate of exposure was evaluated and stratified according to the site (anterior, posterior). No dropouts were observed during the 6 weeks follow-up. All sites underwent uneventful healing with no complications. For posterior teeth, Test 1 and Test 2 showed full healing of the soft tissues with a reduction of the exposed area from 46.5 ± 8.25 mm2 to 0.6 ± 0.84 mm2 and from 47.1 ± 8.67 mm2 to 0.6 ± 0.7 mm2, respectively. The Control group exhibited a reduction from 45.6 ± 7.25 mm2 to 1.2 ± 0.9 mm2. Both Tests 1 and 2, when compared to the Control group, showed statistically significant better healing (p < 0.05). Anterior teeth showed a complete closure of the socket 4 weeks after the extraction with no noticeable differences between Test and Control. Both materials used in this study showed evidence to achieve the purpose. Ethical Guidelines: written informed consent was obtained from the participants of the study, as requested by the Ethics Committee for Health Research Faculty of Dentistry, Universitas Trisakti, with the following number: 641/S3/KEPK/FKG/5/2023.

Custom‐made surgical guide with mucoperiosteal flap elevation function for the removal of multiple impacted supernumerary teeth: A case report

AbstractBackgroundSurgical guides manufactured with computer‐aided design/computer‐aided manufacturing (CAD/CAM) technology are effective tools for oral surgeries.Case presentationA new type of surgical guide with mucoperiosteal flap elevation function was custom designed, printed, and applied for the safe and accurate removal of six impacted supernumerary teeth in a 12‐year‐old male patient. The surgical guides were designed with access holes corresponding to the positions of the impacted teeth and the elevation structures of the mucoperiosteal flap.ConclusionThe novel custom‐made surgical guide system introduced in the present report was successfully utilized for minimally invasive teeth removal procedures.

Biliverdin improved angiogenesis and suppressed apoptosis via PI3K/Akt-mediated Nrf2 antioxidant system to promote ischemic flap survival

Plastic and reconstructive surgeons frequently utilize random skin flap transplantation to repair skin defects. However, the procedure carries a substantial risk of necrosis. Previous research has suggested that Biliverdin (Bv), the main component of Calculus Bovis, possessed potent anti-ischemic properties, making it a potential therapeutic agent for skin flap survival. Hence, in this study, the potential of Bv in promoting flap survival has been comprehensively investigated. Network pharmacology analysis revealed that the pharmacological effects of Bv on ischemic diseases may be attributed to its modulation of various signaling molecules, including the PI3K-Akt pathway. In vitro results demonstrated that Bv treatment significantly promoted angiogenesis in human umbilical vein endothelial cells (HUVEC), even in the presence of H2O2. This was evident by the increased cell proliferation, enhanced migration, and improved tube formation. Bv also effectively attenuated the intracellular generation of reactive oxygen species (ROS) induced by H2O2, which was achieved by suppressing mitochondrial ROS production through the PI3K/Akt-mediated activation of Nrf2/HO-1 signaling pathway. Consequently, Bv treatment led to a significant reduction in apoptosis and an increase in cell viability of HUVEC. Furthermore, in vivo experiment demonstrated that Bv treatment vastly elevated flap survival through enhancing angiogenesis while decreasing oxidative stress and apoptosis, which was comparable to the results of positive control of N-acetylcysteine (Nac). In conclusion, this study not only established a solid foundation for future study on therapeutic potential of Bv, but also proposed a promising treatment approach for enhancing the success rate of flap transplants and other ischemic-related tissue repair.

Noninvasive visualization of the midline-crossing arterial variation in the deep inferior epigastric artery perforator flap using photoacoustic tomography for application in patients with abdominal scars

BackgroundThe importance of the subcutaneous arterial network crossing the midline in transverse abdominal flaps has been reported. Photoacoustic tomography can be used to noninvasively visualize subcutaneous vascular networks. We applied this novel technology preoperatively in patients undergoing breast reconstruction to detect individual variations in the midline-crossing arteries. MethodsSix patients scheduled to undergo breast reconstruction using free deep inferior epigastric artery perforator flaps were examined. Each scan of the 12×8-cm region took approximately 8min. The accuracy of the tentative arteries evaluation defined by photoacoustic tomography was compared with the arterial phase detected by intraoperative indocyanine green angiography. The number of perforator vessels used for the flap, surgical time for flap elevation, and perfusion area ratio were compared with those of the control group. ResultsThe average match rate between tentative arteries prediction by photoacoustic tomography and arterial-phase assessment by intraoperative angiography in 5 patients was 79.8%. Each midline crossing artery showed individual variations. The photoacoustic tomography group (PAT-1 to 5) showed 1.8 perforators per flap, 163minutes for flap elevation, and 93% perfusion area, with no significant differences from the control group (N=5). A 63-year-old woman (PAT-6) with abdominal scars, including a midline abdominal incision, showed a preserved midline crossing artery. The planned single perforator deep inferior epigastric perforator flap was successfully applied to the contralateral perfusion area. ConclusionsPhotoacoustic tomography noninvasively visualizes the subcutaneous midline-crossing arterial networks. Understanding individual vascular variations can support preoperative planning and surgical indication of abdominal flaps, especially in patients with postsurgical scars.

Direct Oral Anticoagulants and Bleeding Management Following Tooth Extractions-A Prospective Cohort Study.

The aim of the present study was to assess the occurrence of intra-, peri-, and post-operative bleeding following tooth extractions in patients treated with direct oral anticoagulants (DOACs). Consecutive patients requiring at least one dental extraction were enrolled. The DOAC regimen was either maintained or suspended. Patients were classified in subgroups depending on the number of teeth extracted per procedure (≤3 or >3), the need for flap elevation, and the performance of osteotomy. Bleeding was recorded intra-operatively; peri-operatively at 20, 40, 60, and 80 min after the procedure; and daily in the first seven days following tooth extractions. Forty-nine patients treated with DOACs (17 with rivaroxaban, 16 with apixaban, 8 with edoxaban, and 8 with dabigatran) were enrolled. Of them, 33 refrained from DOAC administration pre-operatively. The performances of >3 teeth extractions, flap elevation, and osteotomy were significantly associated with higher bleeding rates (p < 0.05). In patients treated with rivaroxaban and apixaban, bleeding episodes were more frequent. Although DOAC treatment may increase the rates of intra-operative, peri-operative, and post-operative bleeding, the recorded episodes were mild and manageable. DOAC suspension may reduce peri-operative bleeding, while no effect could be observed for post-operative bleeding.

The ulnar digital artery perforator flap for little finger defects: Using the abductor digiti minimi as a landmark – Surgical technique

This surgical technique article outlines the planning and harvesting methods for the ulnar digital artery perforator (UDAP) flap, using the abductor digiti minimi as a landmark for flap elevation. This approach demonstrates a reliable perforator and offers a wide range of coverage for little finger reconstruction, both on the palmar and dorsal sides. The UDAP flap is technically straightforward and easily accessible and results in minimal donor site morbidity, making it a highly viable option for little finger defects. The technique’s simplicity and effectiveness represent a significant advancement in reconstructive surgery for the little finger.

Clinical and Micro-CT analyses of Vertical Guided Bone Regeneration of Mandible using a d-PTFE Membrane, Autogenous Bone, and High-Temperature Processed Xenograft- A Case Series Study.

Purpose: To evaluate the efficacy of vertical guided bone regeneration (GBR) in the mandible utilizing a non-resorbable membrane and a bone graft combination of autogenous bone chips, and high-temperature processed (HTP) xenograft, through CT scans and microCT analysis. Materials and Methods: Patients underwent vertical ridge augmentation procedures prior to implant placement. The surgical procedure included flap elevation and placement of a bone graft comprising a 1:1 combination of autogenous posterior mandible-derived bone chips, and HTP xenograft graft particles covered with a d-PTFE membrane trimmed to suit the 3D shape of the bone defect. This was fastened securely with titanium screws and pins, and a layer of native collagen membrane. Post-operative complications and ridge measurements were assessed. Pre bone augmentation and pre implant placement bone parameters were obtained from CT scans. Biopsy specimens collected during implantation were examined by microCT. Results: All 13 study procedures were successful without any complications. The results revealed average vertical and horizontal bone gains of 3.35 mm and 5.15 mm respectively. A total of 33 implants were successfully placed in the augmented areas, without the need for further bone augmentation. MicroCT analysis revealed 48% bone, 15% filler material, and 37% non-calcified tissue in the augmented region compared to 65% bone, 3% filler material, and 32% non-calcified tissue in the pristine bone. Conclusions: A mixture of autogenous bone and HTP xenograft, covered with a d-PTFE membrane and a layer of native collagen membrane is effective for vertical GBR.

The Buccal Mask: Safe Positive Airway Pressure Delivery for Patients with a Paramedian Forehead Flap.

The paramedian forehead flap is commonly performed for the reconstruction of complex nasal defects. It typically requires two separate procedures: flap elevation and inset, and then, 2-3 weeks later, pedicle division. In patients with obesity hypoventilation syndrome, the use of positive airway pressure is often mandatory, especially in the postoperative period. However, the face mask used for positive airway pressure has to apply pressure over the bridge of the nose and may compromise the vascularity of a paramedian forehead flap. We report a case where a buccal mask was used successfully in the postoperative period in a patient who needed positive airway pressure after nasal reconstruction with a paramedian forehead flap.

Two-Step Periosteal Releasing Incision for Tension-Free Flap Closure After Implant Placement With Simultaneous Guided Bone Regeneration.

We evaluated the effect of periosteal-releasing incisions on flap displacement in anterior maxillary sites following implant placement and simultaneously guided bone regeneration. Thirty patients, each requiring a single dental implant and guided bone regeneration in the maxillary esthetic zone, were recruited. After full-thickness flap elevation, the displacement of the flap was measured under a standardized tension of 1 Ncm. Then, a 2-step periosteal releasing incision was placed in the internal aspect of the flap, and the displacement was remeasured using the same standardized tension. Keratinized tissue width and mucosal thickness at the surgical site were recorded. Patient-reported outcomes were assessed at the 7- and 14-day recall visits. Flap displacement (primary outcome) was calculated before and after periosteal-releasing incisions. Multivariable linear regression models were used to evaluate the influence of mucosal thickness on flap displacement and adjusted for Keratinized tissue width. Primary wound closure was achieved in all patients. The mean difference in flap coronal displacement before and after the periosteal-releasing incisions was 8.2 mm (p < .0001). Adjusted regression models showed no association between mucosal thickness and keratinized tissue width with the amount of flap displacement (p = .770). Patient-reported outcome measures for pain, swelling, and bleeding amounted to 1.28 ± 1.93, 1.36 ± 1.87, and 0.0 ± 0.0 at 7 days and 0.11 ± 0.57, 0.56 ± 1.03, and 0.0 ± 0.0 at 14 days, respectively. Periosteal-releasing incisions using the 2-step procedure described here are a predictable technique to obtain coronal flap displacements >8 mm without increased surgical complications.

Double-Flap Elevation From the Ipsilateral Lower Extremity: The Anterior Approach to Fibula Osteo-Cutaneous Flap Elevation.

The free fibular flap has been elevated by a "lateral approach" from the posterior edge of the peroneal muscle for more than 40 years. However, in this approach, the surgical view is limited because flap elevation in mandibular reconstruction is performed simultaneously with tumor resection in the supine position, even when using positioning pillows. We herein propose an "anterior approach" as a new surgical method. We retrospectively investigated free fibular flap surgeries performed using the anterior approach, which consists of three anterior approaches, over a seven-year period. First, to avoid the course of the superficial peroneal nerve, the crural fascia was incised 1-2 cm posterior to the anterior edge of the peroneal muscle. The anterior edge of the peroneus muscle is detached from the anterior intermuscular septum. After performing osteotomies distal and proximal to the fibula, the interosseous membrane was incised from the anterior view. Pulling out the fibula to the anterior space between the anterior intermuscular septum and the peroneal muscle made the surgical field shallow. No postoperative superficial or deep peroneal nerve palsies were found in the 55 patients. Only one tourniquet was used in 31 of the 55 cases (56.4%), with an average of 95 min. Twenty-four patients (43.6%) required a second tourniquet 38 min after an interval. Only one tourniquet was used in 25 of the 30 (83.3%) cases in the last 3 years. Moreover, double flaps were used in 21 cases (38.2%), all of which involved ipsilateral ALT flaps. In 18 cases, double-flap elevation and prefabrication were successfully finished before the completion of tumor resection by otorhinolaryngologists.

Early implant placement versus ridge preservation and delayed implant placement: Analysis of profilometric, clinician- and patient-reported outcomes from a two-centre RCT.

To compare early implant placement (EP) to alveolar ridge preservation and delayed implant placement (ARP/DP) in terms of contour changes, along with clinician- and patient-reported outcome measures (PROMs) until the delivery of the implant-supported restoration. Patients with a failing single tooth in the maxilla or mandible were recruited in two centres. After tooth extraction, patients were randomly assigned (1:1) to either EP or ARP/DP. At abutment connection and crown delivery, the buccal contour changes at 3 mm below the mucosal margin (primary outcome) along with clinician- (ease of treatment) and patient-reported outcomes were assessed using numeric rating scales and OHIP-14. A total of 46 patients were analysed. The mean buccal contour at abutment connection decreased by -1.2 ± 0.6 mm in group EP and -1.6 ± 0.8 mm in group ARP/DP (estimated mean difference; 0.45 [95%CI, -0.02; 0.94]; p = .061) with no significant differences between the groups. ARP/DP was consistently easier than EP across all stages of the surgery (estimated mean difference; 2.0 [95%CI, 1.3; 2.7] p < .001): during flap elevation (EP: 4.8 vs. ARP/DP: 1.6), implant placement (EP: 5.7 vs. ARP/DP: 2.2) and wound closure (EP: 3.4 vs. ARP/DP: 1.6). Both interventions improved quality of life but patients who underwent ARP/DP were significantly more satisfied at the time of crown delivery (ARP/DP: 9.6 vs. EP: 9.1, p = .02). EP and ARP/DP show no significant differences in buccal contour changes, aesthetics and patient-reported outcomes. However, ARP/DP is an easier procedure at all stages of the surgery compared to EP and could therefore be the preferred therapy for less experienced clinicians.

Why Deep Plane Face and Neck Lifting Results in the Maximum Short- and Long-term Results? My Primary Choice for Rhytidectomy in My Practice.

I converted to the extended deep plane facelift and neck lift with a shorter skin flap elevation in the face to achieve a more complete release of the facial ligaments to obtain more mobilization of the skin/superficial musculoaponeurotic system composite flap, and a more medial suspension resulting in improved correction of the midface, nasolabial fold, marionette fold and jowl. Treatment of the deep neck structures allowed for more refinement of the submentum in the deep neck lift procedures as well. In this article, we shall review the surgical technique of the deep plane facelift and neck lift as well as postoperative management pearls, the management of complications from the procedure, and the incorporation of ancillary procedures.

Forehead Flap for Facial Defects Reconstruction: Case Series and Review of The Literature

Introduction: Forehead flap is one of the oldest techniques for reconstruction of the facial defects. Throughout the years, various advances in technologies and surgical techniques are continuously developing. Despite the ongoing advances in technology, forehead flap may be a simpler and useful alternative for facial defects. Method: This study was a retrospective case series of four patients presented to Dr. Kariadi Central-General Hospital during 2021-2022 with facial defects undergoing reconstruction with forehead flap. Case report based on the medical and surgical records. Result: All patients underwent reconstruction surgery in 2 stages. The first stage was flap elevation and transfer, and the second surgery was flap division and inset weeks later. All patients had overall good outcomes. Conclusion: Forehead flap is technically simple to perform, easy to master and provides good outcomes. In cases of free flap loss, a forehead flap can be used as a Plan B. Therefore, forehead flap is a reliable option for facial defect reconstruction and should be mastered especially by general plastic surgeons.

The Piggyback Superficial Circumflex Iliac Perforator Flap for Complex Free Flap Reconstructions.

This article introduces a reproducible strategy for complex reconstruction scenarios that require the use of two flaps. It specifically focuses on the utilization of the superficial circumflex iliac artery perforator (SCIP) flap as a secondary flap, particularly in complex cases where available arterial options are limited. In the first scenario, the SCIP flap is elevated simultaneously during elevation of a fibula bone flap. The pedicle of the fibula flap will be anastomosed to the recipient vessels, and the pedicle artery of the SCIP flap, the superficial circumflex iliac artery, will be anastomosed to the distal end of the peroneal artery. The SCIP flap pedicle offers greater length compared with a cutaneous flap sourced from the peroneal artery, thus providing increased flexibility for the flap inset. In the second scenario, the SCIP flap is combined with the anterolateral thigh (ALT) flap to manage a significant defect. The pedicle of the ALT flap is anastomosed to the recipient vessels, and the superficial circumflex iliac artery is anastomosed to the distal end of the pedicle artery of the ALT flap, the descending branch of the lateral circumflex femoral artery. The SCIP flap can be harvested simultaneously with a fibula flap or an ALT flap from the same side, and its arterial anastomosis can always be established with the distal ends of the arterial pedicle of these two flaps. This efficient and reproducible method can also contribute to minimal donor site morbidity and will be particularly valuable in settings where recipient artery choices are limited.

Surgical delay in abdominal based flap surgery: a scoping review.

The abdominal donor site is the most common flap used for breast reconstruction, with flap necrosis a feared complication. The technique of surgical 'delay' involves the inducing of relative ischemia to promote neovascularisation, amongst other metabolic adaptations, and has been used to augment flap vascularity and reduce this complication. There is significant variability in the manner in which flap surgery and surgical delay may be performed, such as the vessels ligated, the presence and degree of flap elevation, and the decision to harvest muscle with the flap, amongst other factors. A formal review of techniques, however, has not yet been performed, and there is no consensus as to the optimal technique for surgical delay. A scoping review of the current literature was undertaken to determine the optimal surgical delay technique in abdominal-based flap surgery. A literature search was conducted across PubMed, Embase, Cochrane, and Medline databases. Data regarding the type of flap surgery, delay techniques, and corresponding clinical outcomes was collected and categorised by technique type. Nine studies met the inclusion criteria and were included for review. Levels of evidence and rates of complications were compared. The range of surgical delay techniques reported in the literature was described. Surgical delay was found to reduce overall complication rates, and the available data suggests it may be particularly beneficial in high-risk patients. The current data support delay as a viable method for reducing rates of complications. Further studies and data are required to compare surgical delay techniques and determine the benefit delay may pose to patients with risk factors.

Subdermal dissection technique for pure skin SCIA and ALT perforator flaps in burns and trauma defects: Clinical experience.

The pure skin perforator (PSP) flap is gaining popularity for its remarkable thinness. The subdermal dissection technique was recently introduced, allowing for a quicker elevation of a PSP flap. In this report, we present our two-year experience utilizing subdermal dissection for harvesting PSP flaps. All patients who had undergone PSP flap reconstruction at our hospital from February 2021 to February 2023 were included. Demographic data, intraoperative variables, flap characteristics, and postoperative outcomes were collected. Surgical planning involved locating the perforator using ultrasound and harvesting the flap using the subdermal dissection technique. A total of 26 PSP flap reconstructions were conducted on 24 patients aged between 15 and 86 years. The flaps were based on perforators issuing from the superficial circumflex iliac artery in 24 cases, and from the descending branch of the lateral circumflex femoral artery in 2 cases. Flap sizes ranged from 3 × 1.5 cm to 19 × 6 cm, with a mean thickness of 3.48 mm. The average time for flap harvest was 131.92 min. Postoperatively, we observed four cases of partial necrosis, 1 total flap loss, and 2 instances of vascular thrombosis at the anastomosis site. The flaps exhibited good pliability without contracture, and no debulking procedures were required during the follow-up period (minimum 6 months, range 6-24; mean 9.4615). The subdermal dissection technique is a safe and efficient approach for elevating PSP flaps. Our initial experience with this technique has been encouraging, and it currently serves as our preferred reconstructive option for defects requiring thin reconstruction.

Narrow band imaging accentuates differences in contrast between cartilage and perichondrium in the elevation of the muco-perichondrium flap during septoplasty and open septorhinoplasty.

Narrow band imaging accentuates differences in contrast between cartilage and perichondrium in the elevation of the muco-perichondrium flap during septoplasty and open septorhinoplasty.

Reliability and Safety of Super-Thin ALT Flap: A Comprehensive Evaluation of Perfusion-Related Complications and Donor Morbidity.

With an increasing need for thin flap, the use of super-thin anterolateral thigh (ALT) flaps, raised above the supra-superficial fascia, has drawn great attention. Controversy remains regarding whether such thin flap elevation could affect postoperative outcomes, encompassing perfusion-related complications (PRC) and donor morbidities. This study aimed to evaluate the outcomes of super-thin ALT flap-based reconstruction compared with those of suprafascially elevated flaps. Patients who underwent free ALT flap-based reconstruction between March 2017 and June 2023 were reviewed, and categorized into two groups based on flap elevation plane; super-thin, and suprafascial. Development of PRC and donor morbidities including paresthesia, were compared. Independent associations of the elevation plane with complication profiles were evaluated. Further analyses were conducted using propensity-score matching. In total, 208 cases were analyzed: 80 super-thin and 128 suprafascial ALT flaps. Nineteen cases (9.1%) experienced PRC, including four total and 14 partial necrosis. The incidence of overall and each type of PRC did not differ based on flap elevation plane even after adjusting for other variables. The super-thin group exhibited significantly lower donor complications compared to the others, upheld in multivariable analyses. Elevating the flaps with a super-thin fashion allowed for a higher rate of preservation of the lateral femoral cutaneous nerve, resulting in a significantly lower rate of postoperative paresthesia. Similar associations were observed in the propensity-score matching analysis. Super-thin ALT flap elevation might not appear to increase PRC risk, while reduces donor complications, compared to suprafascial elevation.