Background: Modern microsurgical reconstruction aims to achieve functional and satisfactory esthetic outcome and the primary thinning procedure results in one-stage reconstruction. However, current techniques are lacking of preoperative knowledge of the peripheral perforator in the adipose layer. We hypothesized that combination of the knowledge of microvasculature and visualization of such small vessels in the adipose layer by Color Doppler ultrasonography (CDU) will make the dissection of these vessels with simultaneous flap thinning (perforator branch flap technique) feasible in variety of flaps.
Methods: Review of cases with this technique from 2011 to 2020 was conducted. Entire course of the perforator branch in the adipose layer were traced up to the dermis by CDU, and marked on the skin surface. Flaps were elevated with the desired thickness until 1- 2 cm away from the marked dermal entries of the perforator branch. Under loupe magnification, perforator branches were dissected in the adipose layer simultaneously with the primary thinning of the skin flap.
Results: The courses of the perforator branches detected by CDU were accurately corresponded to the surgical findings in all 36 flaps in 32 cases. There was no total flap loss, but partial necrosis was found in one case. A secondary debulking procedure was needed in five flaps.
Conclusions: The knowledge of microvascularature with CDU has made the perforator branch technique possible and allowed to safely transfer the skin flap from various body areas to the defect, thereby, achieving "like with like" reconstruction in one-stage.

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