Anatomic Study of the Lateral Circumflex Femoral Artery System Applied to the Anterolateral Thigh Perforator Flap

Microsurgery has developed since the beginning of the 20th century, progressively using new techniques and better surgical instruments. When perforator flaps were first studied (i.e., flaps based on vessels from a known main artery), Song et al. described the anterolateral thigh flap. This flap has some advantages concerning quality and versatility, and less damage to the donor site, but it has some restriction in its use in occidental countries because of the lack of anatomic studies in that population. In this study, the authors described the anatomic variations and patterns of the femoral lateral circumflex artery and its perforator vessels.

Sixteen thighs were studied from 12 fresh cadavers and compared to the Asian studies. After careful dissection, the femoral lateral circumflex artery descending branch perforator vessels were identified, and the patterns of the vascular anatomy, external diameter, and length were marked. The vascular pattern was classified according to the Kimata et al. classification. The mean age was 61.1 years. Forty-two perforator vessels were identified (mean: 2.62 per flap); 66.7% of the perforator vessels were musculocutaneous, and 33.3% were septocutaneous.

According to the Kimata et al. classification, 10 pedicles were type 1, four presented an association of type 1 and type 4, and two were type 2. The total length of the pedicle, considering each perforator vessel for a flap, ranged from 6.8 cm to 28 cm, with an average of 17.3 cm. The vascular pedicle was constant, long, and of large diameter and followed patterns similar to the Asian studies. The authors thus believe that the anterolateral thigh flap can be used with the same safety as in the Asian population.