A New Recipient Artery for Reconstruction of Soft-Tissue Defects in the Lower Limb with a Free Anterolateral Thigh Flap: The Reversed Descending Branch of the Lateral Femoral Circumflex Artery

Background: Complex and severe leg defects remain a persistent challenge in reconstructive surgery, especially when no feasible local or regional flaps are available. An operative solution is yet to be found. The descending branch of the lateral circumflex femoral artery of the injured leg was used as the recipient artery in a reverse-flow fashion in these difficult wounds. Methods: From March of 2005 to May of 2010, 11 male and four female patients with soft-tissue defects in the lower leg were treated. Causes of injury were industrial machinery injuries in six patients and traffic accidents in nine patients. Mean patient age at surgery was 36.6 years. The mean soft-tissue defect size was 17.6 x 7.4 cm, and the mean anterolateral thigh flap was 19.3 x 8.7 cm. The mean length of flap pedicles was 11.8 cm, and the mean length of recipient pedicles was 15.7 cm. Results: Fourteen flaps survived completely. Partial necrosis at the distal edge of the flap occurred in one case. No patient needed operative revision due to postoperative thrombosis of the vessels. At the mean follow-up period of 10.5 months, wound coverage was achieved in all patients. Conclusions: The reverse descending branch of the lateral circumflex femoral artery is a reliable recipient artery for the free anterolateral thigh flap taken from the opposite thigh. The technique can be used to reconstruct defects in the lower leg when use of local or regional flaps is not feasible and commonly used recipient arteries are not available. (Plast. Reconstr. Surg. 130: 1059, 2012.)