Background: The most untoward aspect of the anterolateral thigh is the complexity of the local vasculature. Failure to understand its variability can lead to vascular flap embarrassment and tissue loss. The authors present a comprehensive summary of the vascular anatomy of the anterolateral thigh. Methods: A MEDLINE search was performed for articles published between 1948 and 2012 on the anterolateral thigh flap. Two levels of screening and manual reference check identified 44 relevant studies. Results: The descending branch of the lateral circumflex femoral artery was variably found to originate from the deep femoral (6.25 to 13 percent) or common femoral artery (1 to 6 percent), instead of the lateral circumflex femoral artery. Dominant perforator supply to the anterolateral thigh was most commonly from the descending (57 to 100 percent), transverse (4 to 35 percent), oblique (14 to 43 percent), or ascending (2.6 to 14.5 percent) branch. Septocutaneous perforators were present in 19.8 percent (0 to 61.5 percent) of cases overall (n = 2486). No perforators were found in 1.8 percent of cases overall (n = 2895). The majority of perforators were found in the central third of the thigh. The previously undescribed musculoseptocutaneous perforator was observed in 21 to 52.3 percent of vascular mapping or anatomic studies, but not in clinical studies. Conclusions: As knowledge of pertinent vascular anatomy for the anterolateral thigh flap has increased, so has insight into the amount of existing variation. This systematic review summarizes the wide spectrum of normal and variant anatomy described in the literature to date. Clinical Question/Level of Evidence: Therapeutic, IV.
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