Anterolateral thigh flap: from anatomic study to surgical technique

Anterolateral thigh flap is a perforator flap, which is vascularised by the descending branch of the lateral circonflex femoral artery. It has been described first by Song in 1984 and is essentially developed in Asia. This flap can be pedicled but it is widely used as a free flap for reconstruction of head and neck defects. Knowing that its vascular anatomy and the variation's origins of the perforators are well documented, our study's objective is to locate the main points of the dissection and its traps, starting from an anatomic study including 15 inferior members. The first constraint is the localisation and the individualisation of intermuscular septum between rectus femoris and vastus lateralis. The perforators of the flap can be septo-cutaneous (14.4%) and then the dissection of the flap is easy but can usually be musculo-cutaneous (86.6%) and the intramuscular dissection in the vastus lateralis represents then the second most difficult period of the intervention. This flap would be frequently used in France thanks to its intrinsic qualities, but due to the difficulty of the dissection of perforators vessels, teams who are intending this operation must make a previous work of anatomic dissection. (C) 2007 Elsevier Masson SAS. Tous droits reserves.