Abstract
Background The anterolateral thigh (ALT) flap has become a predominant option in the field of
reconstruction. However, some difficulties in harvesting flap exist due to the anatomical
variability of the perforators. Reports have provided solutions for unreliable perforators.
Although numerous cases that showed successful conversion to tensor fasciae latae
(TFL) flap or anteromedial thigh (AMT) flap have been reported in the literature,
none fully addresses the reliability of the perforators that have been described to
date. Therefore, we conducted a systematic literature review to compare the reliability
of the TFL flap with that of the AMT flap when an ALT flap perforator is not suitable.
Methods A systematic review of the MEDLINE, PubMed, and Cochrane Library electronic databases
was performed to compare the characteristics of TFL and AMT flap perforators.
Results A total of 13 articles were included for review. The mean number of TFL perforators
varied from 1.41 to 3.17 per thigh. The mean number of AMT perforators was between
0.59 and 1.3 per thigh. The cumulative assessment of the clinical and anatomical studies
showed 456 perforators in 180 TFL flaps (mean, 2.53) and 145 perforators in 162 AMT
flaps (mean, 0.90). The mean pedicle length of the TFL and AMT flaps ranged from 7.0
to 9.59 cm and from 7.4 to 11.0 cm, respectively. The mean perforator diameter was
similar in both flaps.
Conclusion Currently available literature suggests that the TFL flap may be a more reliable
alternative when adequate perforators are not found for ALT flap harvest.
Keywords
thigh - free tissue flaps - perforator flap - microvascular - fascia lata - lower
extremity
