Objective
In this case report, we shared an experience of anterolateral thigh (ALT) flap harvest under the guidance of a mixed reality (MR) device.

Methods
In June 2023, ALT flap reconstruction was performed on a patient who underwent wide excision of a lip tumor in National Taiwan University Hospital, Biomedical Park branch. Preoperative computed tomography angiography (CTA) images of the lower legs were used to generate three-dimensional (3D) models. Then the 3D models were imported into the HoloLens 2, a MR device developed by the Microsoft Corporation. Through the HoloLens, the hologram was projected on the patient, and the orientation was adjusted manually by hand gestures. The vascular structures identified by MR overlay were depicted on the skin and compared to the real anatomic appearance after dissection.

Results
This work demonstrated that the HoloLens allowed the visualization of perforators from the lateral circumflex femoral artery with high accuracy during ALT flap harvest, which aided in skin paddle design and vessel dissection.

Conclusions
The experience gained here suggests that MR navigation in flap harvest seems to possess certain potential of improving preciseness and efficiency, and may be suitable for more complex cases that need detailed preoperative planning and intraoperative guidance.