The anatomical basis for delaying the musculocutaneous tensor fascia lata flap with a distal extension

Summary

Colored gelatin was selectively injected into the branches of the lateral circumflex femoral artery of fetal and adult cadavers, as well as into the popliteal artery of fetuses. Using this technique, it can be shown that the distal third of the lateral thigh skin has a multi-arterial supply. When a musculocutaneous tensor fascia lata flap with a distal extension is elevated, its medial, lateral and distal arterial input is cut off, transforming its skin paddle into a skin flap with a random blood supply. In order to avoid skin necrosis, a delay three weeks prior to the definitive elevation of the flap is recommended. The delay procedure preserves the vascular supply of the skin paddle coming from the superior lateral geniculate artery and the tensor fascia lata artery, establishing an ‘axial’ pattern of vascularization, thereby enhancing flap survival.