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Summary: Background: Whilst soft tissue closure is the priority to prevent infection in open fractures of the lower limb, some patients find that bulky flaps interfere with function and dislike the appearance. We report the outcomes of delayed free anterolateral thigh flap thinning with liposuction. Material and methods: 38 patients treated between 2006 and 2009 were offered flap contouring. 23 chose flap thinning and 15 did not. We measured outcomes using the SF-36v2 questionnaire and cosmetic outcome scores pre and postoperatively at a mean follow up of 12 weeks (range 10–16 weeks). Results: SF-36v2 physical health (PH) scores improved from a mean of 67 preoperatively to 80 postoperatively (p = 0.01) in the thinned group, while mental health (MH) scores remained unchanged (74–72). The mean SF-36v2 scores for the non-thinned group were 77 (PH) and 86 (MH). Following liposuction the median cosmetic outcome scores out of 5 improved from 1 (not at all satisfied) to 4 (very satisfied) postoperatively (p = 0.0005), which was also higher than the non-thinned group (3) [moderately satisfied], p = 0.004). There was no difference in sex, age, BMI and region on the leg of free flap reconstruction between the non-thinned and thinned groups. Conclusions: Delayed contouring of free ALT flaps used for lower limb reconstruction results in improvements in physical health measures and cosmetic outcomes. Patients not requesting thinning are generally satisfied with their reconstruction. [Copyright &y& Elsevier]

Summary: Background: Deep inferior epigastric artery perforator (DIEP) flap has proved to be an effective method in perineal reconstruction. However, a few literatures have reported thinned DIEP flap which yields a better functional and cosmetic result. There are also no clear guidelines on the degree to which a DIEP flap may be debulked of excess tissue before flap viability becomes compromised. In this preliminary report, a series of patients are presented whereby perineal reconstruction was achieved using the pedicled, thinned DIEP flap, based on debulking parameters from our clinical findings. Methods: Between September 2007 and August 2010, 12 pedicled, thinned DIEP island flaps for perineal reconstruction were performed on three patients with vulval or vaginal tumour, five patients with congenital vaginal agenesis and four patients with perineal Paget’s disease. The flap was thinned in the plane inferior to the superficial inferior epigastric vein based on the subcutaneous vasculature of the abdominal wall, as depicted by preoperative computed tomography (CT) angiography (CTA) examination. Results: Preoperative abdominal CTA can perfectly display the anatomy of DIEP flap. With a sensitivity of 100% and a specificity of 100% (Φ > 0.5 mm), it helped in reducing the harvesting time for the flap and in guiding flap thinning. Partial necrosis of the distal flap occurred in a relatively large transverse flap measuring 24 cm × 8.5 cm. One patient experienced dehiscence and a subsequent suture was successfully made. The other ten flaps were transplanted successfully without any complications. Conclusion: This series demonstrates that DIEP flap can be reliably debulked in the plane inferior to the superficial inferior epigastric vein with relatively no risk of necrosis and can be used safely in perineal reconstruction. The abdominal CTA can be employed as an assisting tool to plan the DIEP flap as well as guide flap thinning. [ABSTRACT FROM AUTHOR]