{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:01:55Z","timestamp":1753869715521,"version":"3.41.2"},"reference-count":14,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T00:00:00Z","timestamp":1735948800000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Thinning of anterolateral thigh flap is challenging. Anatomical studies have shown variations in arterial branching patterns in the subcutaneous layer, which were suspected to be the reason for the high frequency of thinning failures. We attempted to visualize subcutaneous arterial courses preoperatively and perform thinning of perforator flaps using this information appropriately. We accumulated evidence on the accuracy of noninvasive vascular visualization using photoacoustic tomography (PAT). In the present case, we applied a medical imaging projection system (MIPS), which enabled real\u2010time surgical navigation using indocyanine green (ICG) emission signals, to use photoacoustic information intraoperatively during the flap thinning procedure. A 69\u2010year\u2010old woman underwent half\u2010tongue resection using the pull\u2010through method for right\u2010sided tongue cancer. Preoperative PAT was performed 5\u2009days before surgery. The 12\u2009\u00d7\u20096\u2010cm area took ~8\u2009min to scan. We used an ICG test card containing ICG\u2010positive control material cut into strips to show tentative artery lines by projection mapping. The transparent vascular map was laminated and sterilized. MIPS captured ICG fluorescence signals that penetrated the anterolateral thigh flap and continuously projected the purple area on the reverse side of the flap, guiding the position of the tentative arteries. A 20\u2009\u00d7\u20096.5\u2010cm anterolateral thigh flap was elevated with the distal part of the reconstructed tongue and proximal de\u2010epithelialized part to fill the pull\u2010thorough tunnel in the submandibular region. Active bleeding was observed when cutting marginal fat tissue near the purple line of the distal ALT flap projected by MIPS. The study protocol did not include a highly invasive trial for MIPS\u2010guided thinning; therefore, we removed minimal marginal fat tissue. The ALT flap showed no postoperative complications while maintaining conversation and swallowing functions. We present the concept of subcutaneous arterial real\u2010time navigation surgery using PAT and MIPS for safe, easy, and fast flap thinning procedures in the future.<\/jats:p>","DOI":"10.1002\/micr.70013","type":"journal-article","created":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T19:59:31Z","timestamp":1736020771000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010Time Subcutaneous Arterial Navigation for Thinning of an Anterolateral Thigh Flap Using Photoacoustic Imaging and Projection Mapping: A Case Report"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2441-979X","authenticated-orcid":false,"given":"Itaru","family":"Tsuge","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Graduate School of Medicine, Kyoto University  Kyoto 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Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics Graduate School of Medicine, Kyoto University  Kyoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goshiro","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics Graduate School of Medicine, Kyoto University  Kyoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Morimoto","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Graduate School of Medicine, Kyoto University  Kyoto 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