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Distally Based Anterolateral Thigh Flap: An Anatomic and Clinical Study

Pan, Shin-Chen M.D.; Yu, Jui-Chin M.D.; Shieh, Shyh-Jou M.D., Ph.D.; Lee, Jing-Wei M.D.; Huang, Bu-Miin Ph.D.; Chiu, Haw-Yen M.D., Ph.D.

Plastic and Reconstructive Surgery: December 2004 - Volume 114 - Issue 7 - p 1768-1775
doi: 10.1097/01.PRS.0000142416.91524.4C
ORIGINAL ARTICLES
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The distally based anterolateral thigh flap has been used for coverage of soft-tissue defects of the knee and upper third of the leg. This flap is based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral system. The purpose of this study was to examine the results of anatomical variations of the descending branch of the lateral circumflex femoral artery and the retrograde blood pressure of the descending branch of the lateral circumflex femoral artery so that the surgical technique for raising and transferring a distally based anterolateral thigh flap to the knee region could be improved. The authors have actually used this flap in three cases. In 11 thighs of six cadavers, the descending branch of the lateral circumflex femoral artery had a rather consistent connection with the lateral superior genicular artery or profunda femoral artery in the knee region. The pivot point, located at the distal portion of the vastus lateralis muscle, ranges from 3 to 10 cm above the knee. In their three cases, the maximal flap size was 7.0 × 16.0 cm and was harvested safely, without marginal necrosis. The mean pedicle length was 15.2 ± 0.7 cm (range, 14.5 to 16 cm). The average proximal and distal retrograde blood pressure of the descending branch of the lateral circumflex femoral artery was also studied in another 11 patients, and the anterolateral thigh flap being used for reconstruction of head and neck defects showed 58.3 and 77.7 percent of proximal antegrade blood pressure, respectively. The advantages of this flap include a long pedicle length, a sufficient tissue supply, possible combination with fascia lata for tendon reconstruction, and favorable donor-site selection, without sacrifice of major vessels or muscles.

Tainan, Taiwan

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, the Institute of Clinical Medicine, and the Department of Anatomy, College of Medicine, National Cheng-Kung University.

Received for publication September 11, 2003; revised December 23, 2003.

Presented at the Eighth Asia Pacific Congress of the International Confederation for Plastic, Reconstructive, and Aesthetic Surgery, in Taipei, Taiwan, April 1 to 4, 2001.

Haw-Yen Chiu, M.D., Ph.D., Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng-Kung University Hospital, 138, Sheng-Li Road, Tainan 704, Taiwan, hychiu@mail.ncku.edu.tw

©2004American Society of Plastic Surgeons