Variations in perforators of anterolateral thigh flap

In our study of anterolateral thigh flaps, ten patients had musculocutaneous perforators (58%), four patients had septocutaneous perforators (24%), and three patients had both types of perforators (18%). Average number of perforators found in each flap was 1.9 (range 14). The maximum number of perforators in a single case was four. A single perforator was found in seven patients. In patients with both types of perforators, larger flaps could be harvested and there were no complications. The study was carried out over a period of 3 years and included 17 patients treated with free anterolateral thigh flaps in our hospital from April 2004 to August 2007. All age groups and both sexes were included in the study. A cadaveric study was done on ten fresh cadavers in the anatomy department of the same hospital. Although the majority of free anterolateral thigh free flaps are based on musculocutaneous perforators and fewer flaps are based on septocutaneous perforators, our study shows that this versatile free flap can be based on a combination of both septocutaneous and musculocutaneous perforators. Though our cadaveric study did not show any flap to be based on the combination of both types of perforators, our clinical study in which we had three cases of this type definitely shows that the ALT flap can be based on a combination of both septocutaneous and musculocutaneous perforators. Further in these cases with both types of perforators, larger flaps could be harvested and with greater flap success.