Distally Based Anterolateral Thigh Flap: An Anatomic and Clinical Study

Abstract

The distally based anterolateral thigh flap has been used for coverage of soft-tissue defects of the knee and upper third of the leg. This flap is based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral system. The purpose of this study was to examine the results of anatomical variations of the descending branch of the lateral circumflex femoral artery and the retrograde blood pressure of the descending branch of the lateral circumflex femoral artery so that the surgical technique for raising and transferring a distally based anterolateral thigh flap to the knee region could be improved. The authors have actually used this flap in three cases. In 11 thighs of six cadavers, the descending branch of the lateral circumflex femoral artery had a rather consistent connection with the lateral superior genicular artery or profunda femoral artery in the knee region. The pivot point, located at the distal portion of the vastus lateralis muscle, ranges from 3 to 10 cm above the knee. In their three cases, the maximal flap size was 7.0 x 16.0 cm and was harvested safely, without marginal necrosis. The mean pedicle length was 15.2 +/- 0.7 cm (range, 14.5 to 16 cm). The average proximal and distal retrograde blood pressure of the descending branch of the lateral circumflex femoral artery was also studied in another 11 patients, and the anterolateral thigh flap being used for reconstruction of head and neck defects showed 58.3 and 77.7 percent of proximal antegrade blood pressure, respectively. The advantages of this flap include a long pedicle length, a sufficient tissue supply, possible combination with fascia lata for tendon reconstruction, and favorable donor-site selection, without sacrifice of major vessels or muscles.

Significance of anatomical variations of the lateral circumflex femoral artery for the tensor fasciae latae flapping

“…Rarely, the transverse branch can be a direct branch of the LCFA or be missing. Sabancıogullari et al [29], and Pan et al [26] reported the same.…”

“…The ascending branch runs under the TFL muscle and anastomosis with the superior gluteal and the deep circumflex iliac arteries and supplies the greater trochanter, the head and the neck of femur [13,15,28,29,31]. Some authors describe that LCFA gives only the ascending and the descending branch, while the transverse one is the branch of the ascending one [17,26]. The TFL flap has a constant vascular supply from the ascending branch of the LCFA with its accompanying commitant veins, and enters the muscle on its deep surface, from 6 cm to 8 cm below the iliac crest at the level of the greater trochanter.…”

Perforator Plus Fasciocutaneous Flaps in the Reconstruction of Post-Burn Flexion Contractures of the Knee Joint

“…The antero-lateral thigh flap is based on the perforators from the descending branch of the lateral circumflex femoral artery, which are clustered within a 3 cm radius of the midpoint of a line which joins the anterior superior iliac spine and the superolateral patella. The descending branch anastomoses with the superior lateral genicular artery, which allows a distallybased flap to be harvested, with the pivot point 3-10 cm above the knee joint [25]. The anteromedial thigh flap is based on a major perforator from the rectus femoris branch of the descending branch of the lateral circumflex femoral artery, which is present in 51% individuals.…”

Colgajo anterolateral del muslo: anatomía quirúrgica, técnica de disección y aplicaciones clínicas

“…También se ha descrito el adelgazamiento del colgajo hasta el extremo de convertirlo en un colgajo meramente cutáneo irrigado por el plexo subdérmico. Presenta la dificultad de la disección microquirúrgica del vaso perforante hasta el plexo subdérmico y se ha utilizado para la cobertura del dorso del pie con la ventaja de obtener un buen resultado cosmético sin la necesidad de desgrasarlo en un segundo tiempo (23).…”