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Three- and Four-Dimensional Computed Tomographic Angiography and Venography of the Anterolateral Thigh Perforator Flap

Schaverien, Mark M.R.C.S.; Saint-Cyr, Michel M.D.; Arbique, Gary Ph.D.; Hatef, Dan M.D.; Brown, Spencer A. Ph.D.; Rohrich, Rod J. M.D.

Plastic and Reconstructive Surgery: May 2008 - Volume 121 - Issue 5 - p 1685-1696
doi: 10.1097/PRS.0b013e31816b4587
Reconstructive: Lower Extremity: Original Articles

Background: This study presents a detailed three- and four-dimensional appraisal of the arterial and venous anatomy and perfusion of the anterolateral thigh flap using a novel computed tomographic technique.

Methods: Eighteen anterolateral thigh flaps harvested from fresh Western cadavers were used. Four-dimensional computed tomographic angiography with injection of iodinated contrast medium into isolated perforators and their venae comitantes was used to investigate the arterial and venous anatomy and flap perfusion. Additional perforators were injected to investigate the vascular connections within the flap. Changes in flap perfusion after thinning and adipofascial flap harvest were also examined, and contrast density within each flap plexus with respect to the perforator was examined.

Results: Large-diameter linking vessels at the suprafascial level enabled perfusion of adjacent vascular territories and of the subdermal plexus between angiotomes. Thinning reduced the size of the vascular territory by ligating recurrent vessels at the level of the suprafascial plexus. Adipofascial flap harvest prevented perfusion of the recurrent vessels, demonstrating the role of the subdermal plexus in recurrent flow. Three distinct perforator complex patterns were found with relevance to flap thinning. A superficial venous system perfused the venae comitantes of the descending branch of the lateral femoral circumflex artery and the long saphenous vein.

Conclusions: A reduction in vascular territory occurs in the anterolateral thigh flap after thinning and is attributable to ligation of vessels within the suprafascial plexus. Recurrent flow through the subdermal plexus was seen dynamically for the first time and appears to be an important mechanism for skin perfusion.


Dallas, Texas

From the Department of Plastic Surgery and the Department of Medical Physics, Division of Radiology, University of Texas Southwestern Medical Center.

Received for publication June 18, 2007; accepted August 27, 2007.

Presented at the 75th Annual Scientific Meeting of the American Society of Plastic Surgeons, in San Francisco, California, October 8, 2006.

Disclosure: The authors have no financial interests in this research project or in any of the techniques or equipment used in this study.

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Michel Saint-Cyr, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390-9132,

©2008American Society of Plastic Surgeons