ANTEROLATERAL THIGH FREE-FLAP

The descending branch of the lateral femoral circumflex artery is a la rge-caliber artery that passes obliquely across the upper third of the thigh and descends between the vastus lateralis and rectus femoris mu scles, It sends perforators through the septum between these muscles a nd through the vastus lateralis muscle and supplies a large area of sk in on the anterolateral aspect of the thigh. We report our experience with our first 44 consecutive anterolateral thigh flaps, which were us ed for a variety of soft-tissue deficits. Twenty-five of these flaps w ere used for lower extremity reconstruction, 10 were used in the upper extremity, and 9 were used in the head and neck. The overall success rate was 96%. Six flaps required reoperation; of these, 2 flaps were l ost, one from a venous thrombosis and the other from arterial thrombos is, both of which were in the lower extremity, In approximately one th ird of cases, the flap was raised as a septofascio-cutaneous flap, but in two thirds it was necessary to include a small segment of vastus l ateralis muscle as well as fascia with the flap. The flap has been par ticularly useful for lower extremity reconstruction, and in patients w ho are not fit for general anesthesia, it is possible to perform the f lap transfer with epidural anesthesia. The flap has the advantage of a long vascular pedicle with large-caliber vessels and thus is suitable as a flow-through flap, It may also be sensate and has provided a ver satile soft-tissue coverage option with minimal long-term donor-site c omplications.