Anterolateral Thigh Perforator Flap

Abstract

When Song et al. published their paper in 1984 on the thigh as a donor site for three new flaps with the anterolateral thigh, they closely fulfilled all the characteristics of a perforator flap [361].

To raise the septocutaneous flap, opening the deep fascia and inclusion of the skin vessel located between the rectus and vastus lateralis muscle were specific components of the operating procedure. But other than elevating a true perforator flap according to the above-mentioned definitions, the conventional anterolateral thigh flap mostly includes a significant amount of subcutaneous fatty tissue. Often, a substantial portion of muscle tissue from the vastus lateralis is included in order to protect the perforating skin vessels and to guarantee a safe blood supply to the skin. Whereas initially the perforators were only visualized or partially exposed at the level of the deep fascia, they are now completely skeletonized along their course from the skin to the source vessel, which mostly is the descending branch of the lateral circumflex femoral artery. Doing this, any muscle tissue is discarded, and the subcutaneous fat is shaped or thinned according to the requirements of the defect. Moreover, different vascular pedicles arising from different source vessels can be used in the anterolateral thigh perforator flap, so that the flap can be raised in a freestyle approach as long as safe anastomosis is provided.