Alternative Vascular Pedicle of the Anterolateral Thigh Flap: The Oblique Branch of the Lateral Circumflex Femoral Artery

Background: The anterolateral thigh flap is known for variations of its vascular pedicle. This is a prospective intraoperative analysis of the vascular anatomy of the lateral thigh that focuses on clinically important variations that impact flap harvest. Methods: Eighty-nine consecutive anterolateral thigh flaps were harvested. A detailed intraoperative analysis was performed of the vasculature anatomy and variations of the pedicle encountered during dissection. Results: Fasciocutaneous flaps were harvested in 82 percent (73 of 89) and myocutaneous flaps were harvested in 17 percent of cases (15 of 89). Sizable perforators were absent in 1 percent of the cases (one of 89). A mean of 1.9 sizable cutaneous vessels were identified. Musculocutaneous perforators were noted in 85 percent of cases and septocutaneous vessels were seen in 15 percent. Most septocutaneous vessels were located in the proximal thigh. In the midpoint of the thigh, musculocutaneous perforators predominate. Those located within 1 cm of the septum characteristically have a short, direct intramuscular course. In contrast, those located more laterally and distally in the thigh characteristically have a tortuous intramuscular course. An oblique branch of the lateral circumflex femoral artery was noted to be present in 35 percent of cases (31 of 88), and the dominant perforator supplying the anterolateral thigh was noted to originate from this branch in 14 percent of cases (12 of 88). Conclusions: This study further clarified the vascular pedicle anatomy of the anterolateral thigh. The existence of the oblique branch of the lateral circumflex femoral artery in a proportion of patients and its reliability when used as the flap pedicle were demonstrated.