Anatomical study of the anterolateral perforators of the thigh and its clinical applications

Anterior thigh skin continued over the years to provide advantageous donor sites for reconstructing defects all over the body. Reconstructive surgery has undergone unceasing alterations and modifications with the sole purpose of securing the best aesthetic and functional outputs. Of these alterations, a landmark shift was brought about by the concept of axiality, which stated that flaps should be categorized according to their vasculature. From there on, more attention was directed to understanding the precise arterial supply of the skin. This article aims to study the cutaneous perforators of the anterolateral thigh and explains their significance in flap design. The material of the present study included thirty fresh cadaveric lower limbs. The external iliac artery (EIA) was injected with colored latex. Superficial, then deep, dissections were undertaken under a magnifying lens to locate the perforators and identify their type according to Cormack's and Lamberty's tripartite system: direct, fasciocutaneous and musculocutaneous perforators. The length and diameter of the perforators were measured. Anterolateral thigh skin was divided into 3 squares. Square 1 is the upper square and comprises the skin over tensor fascia lata (TFL). It is primarily based on the lateral circumflex femoral artery (LCFA), mainly its transverse branch (TB). It divided into three muscular arteries to TFL upon entry of the muscle; upper, middle and lower, and they provided a musculocutaneous perforator in 100%, 60% and 40%, respectively. Squares 2 (middle) and square 3 (lower) are those infamously called the anterolateral thigh flap (ALTF). They are the rest of the anterolateral thigh skin below the TFL and down to the knee. They are mainly based on the descending branch (DB) of the LCFA. It gave two fasciocutaneous perforators at its beginning and termination in all cases; the highest one was for square 2 and the lowest for square 3. The anterolateral thigh skin is richly supplied by a mixture of the three types of perforators. The segmental nature of the perforators arising from the (DB) of the LCFA, together with the superbly long course of the artery itself, grants the famous ALTF its versatility.