Lateral Thigh and Anterolateral Thigh Free Tissue Transfer Workup

  • Author: Joseph L Leach Jr, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jun 16, 2010
 

Laboratory Studies

  • Question the patient about any issues that may disqualify him or her from surgery.
  • Evaluate previous injury or surgery to the thigh.
  • Prepare the patient for a 1-2 week hospital stay with a suction drain in the thigh.
  • No specific lab studies or imaging studies, apart from those indicated for a prolonged procedure under a general anesthetic, are necessary for either thigh free flap.
  • Pinch testing determines the amount of fat in the donor and recipient and also in areas of the flap.
  • Because of an abundance of adipose tissue in the area, the lateral thigh flap is often twice as thick in females. The anterolateral thigh flap is generally less thick.
  • Using a Doppler device to locate the main perforating vessel in the lateral thigh is useful, although not critical. Doppler or color Doppler studies have also been used to identify perforators to the anterolateral thigh flap.
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Joseph L Leach Jr, MD  Associate Professor of Otolaryngology, University of Texas Southwestern Medical School

Joseph L Leach Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Cosmetic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, Texas Medical Association, and Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Larry Leonard Myers, MD  Associate Professor, Division of Head and Neck Oncology and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center; Chief, Section of Otolaryngology-Head and Neck Surgery Surgical Service, Veteran Affairs North Texas Healthcare System; Attending Physician, Children's Medical Center of Dallas and St Paul Medical Center

Larry Leonard Myers, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, and National Medical Association

Disclosure: Nothing to disclose.

John M Truelson, MD, FACS  Chairman, Division of Head and Neck Surgery, Associate Professor, Department of Otorhinolaryngology, University of Texas Southwestern Medical Center at Dallas

John M Truelson, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Phi Beta Kappa, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Terance (Terry) Ted Tsue, MD  Vice-Chairman for Administrative Affairs, Professor, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine

Terance (Terry) Ted Tsue, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Association for Research in Otolaryngology, Johns Hopkins Medical and Surgical Association, Missouri State Medical Association, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David W Stepnick, MD  Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center

David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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Relationship of the perforating vessels of the lateral thigh to the femur is shown. Adductor longus separates the profunda femoris artery (PFA) from the superficial femoral artery.
Design of the flap incorporates a fusiform shape over the intermuscular septum, centered over the midpoint between the trochanter and the lateral femoral condyle. Two thirds of the flap is designed anteriorly because the blood supply is richer in this area.
Identifying the approximate course of the LCFA
This cross-section of the thigh demonstrates third perforators. Successful dissection of the flap requires upward retraction of the vastus lateralis, ligation of tributary branches into the muscles, and freeing the short head of the biceps femoris and the adductor magnus from the femur.
The leg is placed in a padded support. The knee is rotated inwardly to expose the posterolateral aspect of the thigh, including the intermuscular septum.
Initial dissection involves suspension of a rake from a surgical stand to grasp the tough fascia overlying the vastus lateralis. As dissection proceeds medially, the short head of the biceps femoris falls inferiorly. The hemostat indicates the third perforating vessels.
Schematic view of the completed dissection shows that the posterior skin incision has yet to be made. Harvest of the vessels usually is made where the PFA joins with the second perforator (not shown).
Appearance of a healthy flap is shown after anastomosis and inset. Note the pale color in comparison to the surrounding skin.
Identifying the likely location of a perforator for the anterolateral thigh flap. The circle has a 3 cm radius about the midpoint from the ASIS and knee.
The first incision for the anterolateral thigh flap is placed medially, over the rectus femoris muscle.
Closing the donor site for the anterolateral thigh flap is usually straightforward. Skin grafting is necessary for larger defects.
 
 
 
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