Thinning the Flaps: Superthin, Ultrathin, and Pure Skin Flaps

The utilization of free flap transfer has enabled the treatment of defects in hard-to-reach areas of the body where local flaps are not feasible. This technique has been particularly advantageous in the treatment of malignant tumors, which often require extensive ablation. Despite the addition of numerous flaps to the surgical toolbox, bulky flaps remained a persistent issue in reconstruction procedures. In cases where a very thin flap was necessary, such as on the hand or dorsum of the foot, or when harvesting a flap from an obese patient, microsurgeons were compelled to develop methods for thinning the flap. This chapter will delve into the history of flap thinning, the anatomy of dermal perforators, preoperative imaging techniques for flap thinning, and strategies for achieving ultrathin flaps, akin to skin grafts.