Anterolateral Thigh / Vastus Lateralis Flap

Abstract

In 1984, Song and co-workers described the thigh as a donor site for three new flaps, which they raised from its posterior, anteromedial, and anterolateral aspects [361]. Of these three flaps, the anterolateral thigh flap became most popular, especially in head and neck reconstruction. Although originally described as a fasciocutaneous flap that is fed by a septocutaneous perforator of the descending branch of the lateral circumflex femoral artery, the design of the flap significantly depends on the course and location of the cutaneous vessels, the anatomy of which can vary considerably. Because the perforator often takes its course through the vastus lateralis muscle instead of running strictly along the intermuscular septum, parts of the vastus lateralis muscle have to be included in the flap in these cases. In addition to the possibility of raising large skin paddles on a single perforating vessel, the vastus lateralis muscle can be transferred as a muscle-only flap, since it is safely perfused by the descending branch. Thus, a number of flap raising possibilities exist at the anterolateral thigh, offering a wide spectrum of flaps to be harvested. In one of the first large clinical series, Zhou et al. described successful transplantation of this flap in 32 patients, most of them having defects in the region of the face and scalp [450].