Chapter 2 INTRODUCTION The anterolateral thigh flap is a fasciocutaneous flap based on septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral arterial system. This flap is used mainly in reconstructions of head and neck defects after cancer ablation.1-4Its popularity, which is greater in the Orient than in the West, is restricted by the variable anatomy of its vascular pedicle and consequently by its difficult dissection.1-14 We performed an anatomic study on white cadavers at the Human Anatomic Institute, Macroscopic Section, of Ludwig-Maximilian University in Munchen, Germany, to assess the anatomic pattern and the caliber of the lateral circumflex femoral arterial system. MATERIALS AND METHODS We studied 11 cadavers. However, we could dissect only 16 thighs be- cause three of them had been previously amputated transfemorally and the other three had been damaged by other surgical procedures. We used frozen, untreated cadavers. Twenty-four hours before dissection they were positioned on the dissection table to defrost. Twelve hours before dissection they were injected with a resin to allow better observation of all the perforator vessels. In every thigh, we injected 200 ml resin at the Malgaigne line (superficial projection of the groin ligament) in the external iliac artery, which had been previously cannulated (Fig 2.1A). Moreover, we had previously tied the popliteal artery of each side. We used a mixture of an autopolymerizing resin (Biodur) composed of 100 g Biodur E 20, 45 g Biodur E 2, 20 g Biodur Weichmacher AE 10, and 40 g acetone. The resin had a hardening time of approximately 12 hours. In each cadaver, the legs were fixed on the dissection table in an intrarotated position to identify the correct reference points. An antero-lateral thigh flap (20x15 cm, vertical by horizontal) was designed and centered at the midpoint of a line drawn from the anterior superior iliac spine to the superolateral border of the patella. This line represents the superficial projection of the intermuscular septum between the rectus femoris and the vastus lateralis muscles4 (Fig 2.1B). We began the dissection at the medial border of the flap, over the rectus femoris muscle, to prevent injuries to the septocutaneous perforators and to access the vascular pedicle of the anterolateral thigh flap. The flap was then elevated and its perforating vessels were dissected up to their origin from the lateral circumflex femoral arterial branches. The lateral circumflex 21
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