Objective
The use of thin flaps in reconstruction of certain areas such as head and neck provides better aesthetic and functional outcomes. Traditionally, secondary debulking procedures are performed months after the primary procedure. Recently, thinning a perforator flap during its harvest has become more popular as the insights into perforator anatomy and the evolution of microsurgical techniques advanced. We adopted the method of peripheral pruning of anterolateral thigh free flap after convention harvest. After flap elevation, peripheral pruning was started leaving a 2 cm diameter cuff around the perforator. Excision of sub-Scarpa's fat was performed under 2.5x loupe magnification with 6-8 watts of monopolar instrument. Indocyanine green fluorescence imaging was utilized to access the perfusion of the flap before and after the thinning procedure.

Material and Methods
A retrospective review of 10 consecutive ALT free flaps with primary thinning performed at a single institution was done. Data was collected including patient age, sex, body mass index, smoking history, defect location, flap size, flap thickness, and complications.

Results
All of the recipient defects were buccal defects. Flap average size is 47mm x 58mm. The average thickness of the flap before thinning was 17.9mm and the average thickness after flap thinning was 5.9mm. There was no partial or total flap loss during 1 month follow up.

Conclusions
Thinning of flap after flap elevation with peripheral pruning leaving a 2 cm diameter cuff is our experience is a safe and fast method. More studies are needed to elucidate the effects of thin flap on quality of life, satisfaction, and complications.