Lateral Circumflex Femoral Arterial System and Perforators of the Anterolateral Thigh Flap: An Anatomic Study

Abstract

The authors performed an anatomic study on 16 thighs of 11 fresh white cadavers at the Ludwig-Maximilian University of Munchen, Germany. They analyzed the anatomic pattern and caliber of both the lateral circumflex femoral arterial system and the perforators nourishing the anterolateral thigh flap. They found regularly a majority of musculocutaneous perforators, mainly in the central third of the thigh, arising from the descending branch of the lateral circumflex femoral artery. Despite the small number of cadavers, they identified several differences in the anatomy of the lateral circumflex femoral arterial system. These variabilities, especially regarding the descending branch and its perforators, could have clinical importance. They also suggest new dissection studies by comparing white and oriental anatomy. Their aim is to establish whether any difference in the variability of the lateral circumflex femoral arterial system could increase the popularity, currently greater in Eastern Europe, of the anterolateral thigh flap.

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

“…The average skin area dyed on the TFL flap, vascularised by the perforating branches of the ascending branch of the LCFA was 20 × 24 cm -similar to the data from the literature [14,16,35]. The distance of the far distal point of the dyed skin area from the anterior superior iliac spine was 24 cm in average, which is a point of orientation in length of the rotation arc of the flap in surgery [14].…”

“…In some studies it was shown that they both arise from FA in different percentages (0.5%, 0.9% and 1.5%) [2,9,34]. Our material did not show the origin of the ascending and the descending branches from any other blood vessel, which has been presented by some other research [29,35].…”

“…Understanding the TFL muscle blood supply allows a safe transposition of the muscle, as well as the skin superficial to it [4,14,35,36].…”

The variable origin of the lateral circumflex femoral artery: a meta-analysis and proposal for a new classification system

“…Detailed anatomical knowledge about the LCFA is useful in a number of clinical procedures, including aortopopliteal bypass [10,29], anterolateral thigh flaps [33], and coronary artery bypass grafting [8], thus giving its normal and variant anatomy a high degree of clinical significance. Furthermore, its branches may also be used in various procedures.…”

“…The LCFA is used in a diverse number of clinical procedures, including aortopopliteal bypass [10,29], anterolateral thigh flaps [33] and coronary artery bypass grafting [8], giving its normal and variant anatomy a high degree of clinical significance. Furthermore, its branches may also be used in various procedures, for example its ascending branch is often used for vascularised iliac transplant, and its descending branch can be used as a collateral for an obstructed superficial femoral artery (SFA) [12,32].…”