J Korean Assoc Oral Maxillofac Surg.  2016 Oct;42(5):265-270. 10.5125/jkaoms.2016.42.5.265.

Surgical implications of anatomical variation in anterolateral thigh flaps for the reconstruction of oral and maxillofacial soft tissue defects: focus on perforators and pedicles

Affiliations
  • 1Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea. jeehoman@naver.com

Abstract


OBJECTIVES
To gain information on anatomical variation in anterolateral thigh (ALT) flaps in a series of clinical cases, with special focus on perforators and pedicles, for potential use in reconstruction of oral and maxillofacial soft tissue defects.
MATERIALS AND METHODS
Eight patients who underwent microvascular reconstructive surgery with ALT free flaps after ablative surgery for oral cancer were included. The number of perforators included in cutaneous flaps, location of perforators (septocutaneous or musculocutaneous), and the course of vascular pedicles were intraoperatively investigated.
RESULTS
Four cases with a single perforator and four cases with multiple perforators were included in the ALT flap designed along the line from anterior superior iliac spine to patella. Three cases had perforators running the septum between the vastus lateralis and rectus femoris muscle (septocutaneous type), and five cases had perforators running in the vastus lateralis muscle (musculocutaneous type). Regarding the course of vascular pedicles, five cases were derived from the descending branch of the lateral circumflex femoral artery (type I), and three cases were from the transverse branch (type II).
CONCLUSION
Anatomical variation affecting the distribution of perforators and the course of pedicles might prevent use of an ALT free flap in various reconstruction cases. However, these issues can be overcome with an understanding of anatomical variation and meticulous surgical dissection. ALT free flaps are considered reliable options for reconstruction of soft tissue defects of the oral and maxillofacial area.

Keyword

Anterolateral thigh flap; Perforator; Vascular pedicle

MeSH Terms

Femoral Artery
Free Tissue Flaps
Humans
Mouth Neoplasms
Patella
Quadriceps Muscle
Running
Spine
Thigh*

Figure

  • Fig. 1 Septocutaneous perforator and musculocutaneous perforator.

  • Fig. 2 The course of vascular pedicles was categorized into three types. In type I (A), the main pedicle derives from the descending branch of the lateral circumflex femoral artery (LCFA). In type II (B), the vascular pedicle is derived from the transverse branch of the LCFA instead of the descending branch. The vascular pedicle in type III (C) directly arises from the profunda femoris artery. (A: ascending branch, T: transverse branch, D: descending branch, PFA: profunda femoris artery, P: perforator, RF: rectus femoris muscle, VL: vastus lateralis muscle)

  • Fig. 3 Dissection of the musculocutaneous perforator and septocutaneous perforator. In the case of a musculocutaneous perforator (A), meticulous intramuscular dissection around the perforator should be performed to elevate a cutaneous soft tissue flap. The perforator and pedicle were easily elevated in the case of a septocutaneous perforator (B).


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