Anatomical variability of the anteriolateral thigh flap

The aim of the present study is to analyze the variability of the vascular anatomy of the anterolateral thigh flap. Since May, 2011 through September, 2014 47 patients aged between 36 and 78 y were operated on. 31 patients were operated due to oral cavity cancer, 12 - oropharyngeal cancer, 2 - hypopharyngeal cancer, 1 - maxillary cancer and 1 - locally advanced basal squamous cell carcinoma. There were 45 simultaneous reconstructions. There were 40 primary cases, 5 patients were operated due to recurrences after radiation therapy. Among primary patients 39 had stage III-IV disease. Typical anatomy of the anterolateral thigh flap was encountered in 40 cases (85,1%). 7 flaps had atypical anatomy with 4 variants. Among 55 dissected perforators 43 (78,2%) had intramuscular and 12 (22,8%) - septocutaneous course. The descending branch of the lateral circumflex femoral artery was the source vessel in 43 cases, transverse branch of the same artery - in 3 and the unnamed branch of the profunda femoral artery - in 1 case. There were 24 fasciocutaneous and 23 musculocutaneous flaps with the mean size of the skin paddle of 61,7 cm2. Those 47 flaps were raised out of 48 attempts to do so. Suitable perforator was not found in 1 case (2,1%). 2 flaps were lost due to arterial thrombosis. There were 2 cases of partial flap necrosis. The overall success rate in this series was 95,7% (45 out of 47 cases). High variability of the vascular anatomy of the anterolateral thigh flap should be considered by the surgeon.