Laboratory Studies
See the list below:
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Question the patient about any issues that may disqualify him or her from surgery.
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Evaluate previous injury or surgery to the thigh.
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Prepare the patient for a 1-2 week hospital stay with a suction drain in the thigh.
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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.
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Pinch testing determines the amount of fat in the donor and recipient and also in areas of the flap.
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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.
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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.
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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.
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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.
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Identifying the approximate course of the LCFA
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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.
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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.
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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.
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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).
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Appearance of a healthy flap is shown after anastomosis and inset. Note the pale color in comparison to the surrounding skin.
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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.
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The first incision for the anterolateral thigh flap is placed medially, over the rectus femoris muscle.
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Closing the donor site for the anterolateral thigh flap is usually straightforward. Skin grafting is necessary for larger defects.
