Is the Oblique Branch a Preferable Vascular Pedicle for Anterolateral Thigh Free Flaps?

Abstract

Background The oblique branch of the lateral circumflex femoral artery is considered an alternative vascular pedicle of the anterolateral thigh (ALT) flap. However, the oblique branch has several advantages over the descending branch.

Methods A total of 61 consecutive ALT free flaps were harvested according to Yu's ABC system. Vascular pedicle dimensions and length, artery course, perforator origins, and flap harvest time with the oblique branch or the descending branch were recorded. We classified the ALT flaps with oblique branches into three types according to the origin of perforator B. Type I flaps were those where perforator B originated from the descending branch. Type II flaps were those without perforator B. Type III flaps were those where perforator B originated from the oblique branch.

Results The mean ± standard deviation (SD) diameter of the oblique branch at its origin was 1.68 ± 0.51 mm, with an average ± SD pedicle length of 12.92 ± 3.7 cm, while that of the descending branch was 2.27 ± 0.49 mm and 18.73 ± 5.14 cm, respectively. The percentage of septocutaneous perforators from the oblique branch was 35.59%, while that from the descending branch was 15.38%. The flap harvest time with the oblique branch was 33.73 ± 11.68 minutes, while that of the descending branch was 52.27 ± 7.21 minutes. Based on the origin of perforator B, 7 cases had type I ALT flaps, 4 had type II ALT flaps, and 10 had type III ALT flaps. Various ALT flaps based on the oblique branch were harvested, and good clinical results were achieved.

Conclusion The oblique branch is sufficiently large and can be reliably used as the flap pedicle. It may be the preferred vascular pedicle for ALT free flaps.

Keywords

anterolateral thigh flap - oblique branch - lateral circumflex femoral artery

• References

• 1 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37 (02) 149-159
• 2 Xu DC, Zhong SZ, Kong JM. , et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg 1988; 82 (02) 305-310
• 3 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109 (07) 2219-2226 , discussion 2227–2230
• 4 Kuo YR, Jeng SF, Kuo MH. , et al. Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site. Plast Reconstr Surg 2001; 107 (07) 1766-1771
• 5 Kimata Y, Uchiyama K, Ebihara S. , et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 2000; 106 (03) 584-589
• 6 Chen HC, Tang YB. Anterolateral thigh flap: an ideal soft tissue flap. Clin Plast Surg 2003; 30 (03) 383-401
• 7 Wong CH, Wei FC, Fu B, Chen YA, Lin JY. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg 2009; 123 (02) 571-577
• 8 Rozen WM, Ashton MW, Pan WR. , et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery 2009; 29 (01) 16-23
• 9 Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 1998; 102 (05) 1517-1523
• 10 Seth R, Manz RM, Dahan IJ. , et al. Comprehensive analysis of the anterolateral thigh flap vascular anatomy. Arch Facial Plast Surg 2011; 13 (05) 347-354
• 11 Wong CH. The oblique branch trap in the harvest of the anterolateral thigh myocutaneous flap. Microsurgery 2012; 32 (08) 631-634
• 12 da Costa AC, Lancelotti CL. Oblique branch of the lateral circumflex femoral artery also found in 32 percent of cadavers in Brazil. Plast Reconstr Surg 2009; 124 (03) 1011-1012 , author reply 1012–1013
• 13 Lee YC, Chen WC, Chou TM, Shieh SJ. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications. Plast Reconstr Surg 2015; 135 (04) 1097-1107
• 14 Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg 2006; 118 (04) 928-933 , discussion 934–935
• 15 Pappalardo M, Jeng SF, Sadigh PL, Shih HS. Versatility of the free anterolateral thigh flap in the reconstruction of large defects of the weight-bearing foot: a single-center experience with 20 consecutive cases. J Reconstr Microsurg 2016; 32 (07) 562-570
• 16 Jiang C, Guo F, Li N. , et al. Multipaddled anterolateral thigh chimeric flap for reconstruction of complex defects in head and neck. PLoS One 2014; 9 (09) e106326
• 17 Boca R, Kuo YR, Hsieh CH, Huang EY, Jeng SF. A reliable parameter for primary closure of the free anterolateral thigh flap donor site. Plast Reconstr Surg 2010; 126 (05) 1558-1562
• 18 Liu L, Cao X, Zou L, Li Z, Cao X, Cai J. Extended anterolateral thigh flaps for reconstruction of extensive defects of the foot and ankle. PLoS One 2013; 8 (12) e83696
• 19 Shieh SJ, Chiu HY, Yu JC, Pan SC, Tsai ST, Shen CL. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 2000; 105 (07) 2349-2357 , discussion 2358–2360
• 20 Maruccia M, Orfaniotis G, Ciudad P. , et al. Application of extended bi-pedicle anterolateral thigh free flaps for reconstruction of large defects: a case series. Microsurgery 2018; 38 (01) 26-33
• 21 Zhao Y, Qiao Q, Liu Z. , et al. Alternative method to improve the repair of the donor site of the anterolateral thigh flap. Ann Plast Surg 2002; 49 (06) 593-598
• 22 Kawai K, Imanishi N, Nakajima H, Aiso S, Kakibuchi M, Hosokawa K. Vascular anatomy of the anterolateral thigh flap. Plast Reconstr Surg 2004; 114 (05) 1108-1117
• 23 Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg 2012; 130 (06) 1254-1268
• 24 Rozen WM, le Roux CM, Ashton MW, Grinsell D. The unfavorable anatomy of vastus lateralis motor nerves: a cause of donor-site morbidity after anterolateral thigh flap harvest. Plast Reconstr Surg 2009; 123 (05) 1505-1509
• 25 Wong CH, Ong YS, Wei FC. Revisiting vascular supply of the rectus femoris and its relevance in the harvest of the anterolateral thigh flap. Ann Plast Surg 2013; 71 (05) 586-590
• 26 Maruccia M, Di Taranto G, Nicoli F, Ciudad P, Giudice G, Chen HC. Rectus femoris muscle necrosis: an underrated donor-site complication of free anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2017; 70 (07) 972-974
• 27 Lakhiani C, DeFazio MV, Han K, Falola R, Evans K. Donor-site morbidity following free tissue harvest from the thigh: a systematic review and pooled analysis of complications. J Reconstr Microsurg 2016; 32 (05) 342-357
• 28 Renganathan G, Karthikeyan G, Vishwanath G, Singh SK, Venkatnaryanan R. Clinical study to analyze the intramuscular anatomy of musculocutaneous perforators of anterolateral thigh flaps. J Reconstr Microsurg 2017; 33 (09) 619-623