J Reconstr Microsurg 2020; 36(08): 616-624
DOI: 10.1055/s-0040-1713668
Original Article

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Oriana D. Cohen
1  Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
,
Salma A. Abdou
2  Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Ian T. Nolan
1  Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
,
Pierre B. Saadeh
1  Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
› Author Affiliations

Abstract

Background The anterolateral thigh (ALT) flap is a useful flap with minimal donor site morbidity. Preoperative computed tomographic angiography (CTA) for lower extremity reconstruction can determine vessel integrity and plan for recipient vascular targets. This study reviews lower extremity CTAs to further characterize ALT vascular anatomy and associated clinical implications thereof.

Patients and Methods Lower extremity CTA studies were retrospectively reviewed, and information on ALT cutaneous perforator location, origin, and course was collected.

Results A total of 58 lateral circumflex femoral artery (LCFA) systems in 31 patients were included. Average age was 38.8 ± 15.9 years with mean body mass index of 27.2 ± 5.7 kg/m2. The majority of patients were females (23, 74.2%). The LCFA most commonly originated from the profunda femoris artery (87.3%), followed by the distal common femoral artery (9.1%). On average, there were 1.66 ± 0.69 cm perforators per extremity, with an average of 5.38 cm between adjacent perforators. Perforators originated from the descending branch of the LCFA in 89.6% of studies. Perforator caliber was <1 mm (29, 30.2%), 1 to 2 mm (55, 57.3%), or >2 mm (12, 12.5%). Mean distance from the most proximal perforator to the anterior superior iliac spine was 20.4 ± 4.82 cm. Perforators were musculocutaneous (46.9%), septocutaneous (34.4%), or septomyocutaneous (18.8%). In 58.1% of patients, only one thigh had easily dissectable septocutaneous and/or septomyocutaneous perforators, in which case preoperative CTA aided in donor thigh selection.

Conclusion ALT flap cutaneous perforator anatomy varies considerably. Using CTA, we report on rates of septocutaneous, myocutaneous, and septomyocutaneous perforators and underscore its utility in perforator selection.

Funding

None.




Publication History

Received: 01 February 2020

Accepted: 17 May 2020

Publication Date:
08 July 2020 (online)

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