The extended anterolateral thigh flap: Anatomical basis and clinical experience

BACKGROUND: Reports suggest that the anterolateral thigh flap can be reliably extended to include adjacent vascular territories. The vascular basis of this phenomenon is poorly understood. This study examines the three- and four-dimensional arterial and venous anatomy of the extended anterolateral thigh flap and reports the results of a clinical series of extended anterolateral thigh flaps. METHODS: Fifteen anterior hemithigh specimens harvested from fresh cadavers from the Western population were studied. Four-dimensional computed tomographic angiography was used to investigate the arterial and venous anatomy and pattern of perfusion. Injection of perforators within the lateral femoral circumflex femoral vascular territory, and those of the common femoral and superficial femoral arteries, was performed to investigate the vascular connections within the extended anterolateral thigh flap. Static three-dimensional imaging and latex dissections were also performed to confirm the results. A clinical series of 12 consecutive patients is also reported in which extended anterolateral thigh flaps were used for posttrauma or postoncologic reconstruction. RESULTS: Large-diameter linking vessels at the suprafascial level enabled perfusion of the adjacent common femoral and superficial femoral artery vascular territories. In the clinical series, the flap cutaneous territory ranged from 250 to 630 cm (mean, 365 cm), with all flaps except one perfused by a single perforator. No partial or complete flap losses occurred. CONCLUSIONS: This study reports the vascular basis and clinical safety of the extended anterolateral thigh flap, which can be harvested if the linking vessels between adjacent vascular territories in the anterior thigh are preserved. The extended flap is reliably perfused by a single dominant perforator.