Design of Anterolateral Thigh Composite Flap on the Angiosome Principle

To investigate the three-dimensional vasculature of the anterolateral thigh composite flap and to determine its efficacy in the reconstruction of foot injuries with bone defect.Methods Ten fresh cadaver specimens and ten formalin-kept cadaver specimens were examined after infusion with a radio-opaque lead oxide mixture.The vascular anatomy of the lateral circumflex femoral artery to the skin,the muscles,and the periosteum of the bone of the thigh were studied.The anterolateral thigh composite flap based on the lateral circumflex femoral artery was used for foot reconstruction in 6 cases.Results The uppermost portion of the vastus lateralis muscle was supplied by 1 or 2 branches of the transverse branch of the lateral circumflex femoral artery.The descending branch of the lateral circumflex femoral artery entered the vastus lateralis 8～18 cm below its origin.It descended vertically,sometimes,along the anterior edge of the vastus lateralis,and gave off 5～10 branches which ran at an inferolateral direction into the muscle. Meanwhile,it gave off 3～5 musculocutaneous or septocutaneous perforators to the overlying skin.The transverse branch and the descending branch of the lateral circumflex femoral artery also sent the branches to the periosteum of femoral bone. The posterior portion of the muscle received three perforating arteries from the profunda femoral artery.Fine vascular communication was found between the territories of the descending branch of the lateral circumflex femoral artery and the perforating arteries of the profunda femoral artery.All six anterolateral thigh composite flaps survived.Conclusion This anatomical study provides further information to design or redesign the anterolateral thigh composite flap,especially when composite tissues are included in the flap.The anterolateral thigh composite flap is a reliable and versatile reconstruction method.