Reseach development of vascular anatomy and preoperative design technology of anterolateral thigh flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DUANJiazhang ¹ , HEXiaoqing ² ,  XUYongqing ²

1. Brigade of Postgraduate Management, Third Military Medical University, Chongqing, 400038, P. R. China;
2. Department of Orthopedics, Kunming General Hospital of Chengdu Military Region;

Corresponding author：

XUYongqing, Email: xuyongqingkm@163.net

Keywords：

Anterolateral thigh flap; Vascular anatomy; Preoperative design technology

DOI：

10.7507/1002-1892.20160182

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the present status and progress of vascular anatomy and preoperative design technology of the anterolateral thigh flap. Methods The relative researches focused on vascular anatomy and preoperative design technology of the anterolateral thigh flap were extensively reviewed, analyzed, and summarized. Results Vascular anatomy of the anterolateral thigh flap has been reported by numerous researchers, but perforators' location, origin, course, and the variation of the quantity have been emphasized. Meanwhile, the variation of descending branch, oblique branch, and lateral circumflex femoral artery has also been widely reported. Preoperative design technology of the anterolateral thigh flap includes hand-held Doppler, Color Doppler, CT angiography (CTA), magnetic resonance angiography, digital subtraction angiography, and digital technology, among which the hand-held Doppler is most widely used, and CTA is the most ideal, but each method has its own advantages and disadvantages. Conclusion There is multiple variation of vascular anatomy of the anterolateral thigh flap. Though all kinds of preoperative design technologies can offer strong support to operation of anterolateral thigh flap, a simple, quick, precise, and noninvasive technology is the direction of further research.

Citation： DUANJiazhang, HEXiaoqing, XUYongqing. Reseach development of vascular anatomy and preoperative design technology of anterolateral thigh flap. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 909-914. doi: 10.7507/1002-1892.20160182 Copy

1.	Lee YC, Chen WC, Chou TM, et al. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications. Plast Reconstr Surg, 2015, 135(4): 1097-1107.
2.	Lin CT, Wang CH, Ou KW, et al. Clinical applications of the pedicled anterolateral thigh flap in reconstruction. ANZ J Surg, 2015. [Epub ahead of print].
3.	Wei FC, Suominen S, Cheng MH, et al. Anterolateral thigh flap for postmastectomy breast reconstruction. Plast Reconstr Surg, 2002, 110(1): 82-88.
4.	Ali RS, Bluebond-Langner R, Rodriguez ED, et al. The versatility of the anterolateral thigh flap. Plast Reconstr Surg, 2009, 124(6 Suppl): e395-407.
5.	Lin SJ, Rabie A, Yu P. Designing the anterolateral thigh flap without preoperative Doppler or imaging. J Reconstr Microsurg, 2010, 26(1): 67-72.
6.	Luo S, Raffoul W, Luo J, et al. Anterolateral thigh flap: A review of 168 cases. Microsurgery, 1999, 19(5): 232-238.
7.	Choi SW, Park JY, Hur MS, et al. An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap. J Craniofac Surg, 2007, 18(4): 866-871.
8.	Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg, 2006, 118(4): 928-935.
9.	Zachara M, Drozdowski P, Wysocki M, et al. Anatomical variability of the anterolateral thigh flap perforators between sexes: a cadaveric study. Eur J Plast Surg, 2013, 36(3): 179-184.
10.	Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2): 571-577.
11.	Yildirim S, Gideroglu K, Akoz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg, 2003, 19(4): 225-233.
12.	Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck, 2004, 26(9): 759-769.
13.	Wolff KD, Holzle F, Kolk A, et al. Suitability of the anterolateral thigh perforator flap and the soleus perforator flap for intraoral reconstruction: a retrospective study. J Reconstr Microsurg, 2011, 27(4): 225-232.
14.	Zhang Q, Qiao Q, Yang X, et al. Clinical application of the anterolateral thigh flap for soft tissue reconstruction. J Reconstr Microsurg, 2010, 26(2): 87-94.
15.	Seth R, Manz RM, Dahan IJ, et al. Comprehensive analysis of the anterolateral thigh flap vascular anatomy. Arch Facial Plast Surg, 2011, 13(5): 347-354.
16.	Kim EK, Kang BS, Hong JP. The distribution of the perforators in the anterolateral thigh and the utility of multidetector row computed tomography angiography in preoperative planning. Ann Plast Surg, 2010, 65(2): 155-160.
17.	Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
18.	Sananpanich K, Tu YK, Kraisarin J, et al. Flow-through anterolateral thigh flap for simultaneous soft tissue and long vascular gap reconstruction in extremity injuries: anatomical study and case report. Injury, 2008, 39 Suppl 4: 47-54.
19.	Shieh SJ, Chiu HY, Yu JC, et al. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2349-2360.
20.	Pan SC, Yu JC, Shieh SJ, et al. Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg, 2004, 114(7): 1768-1775.
21.	Chou EK, Ulusal B, Ulusal A, et al. Using the descending branch of the lateral femoral circumflex vessel as a source of two independent flaps. Plast Reconstr Surg, 2006, 117(6): 2059-2063.
22.	Gao SH, Feng SM, Chen C, et al. A new recipient artery for reconstruction of soft-tissue defects in the lower limb with a free anterolateral thigh flap: the reversed descending branch of the lateral femoral circumflex artery. Plast Reconstr Surg, 2012, 130(5): 1059-1065.
23.	Wong CH. The oblique branch trap in the harvest of the anterolateral thigh myocutaneous flap. Microsurgery, 2012, 32(8): 631-634.
24.	Wong CH, Goh T, Tan BK, et al. The anterolateral thigh perforator flap for reconstruction of knee defects. Ann Plast Surg, 2013, 70(3): 337-342.
25.	Valdatta L, Tuinder S, Buoro M, et al. Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg, 2002, 49(2): 145-150.
26.	高建华, 罗力生, 陈林峰, 等.股前外侧皮瓣主要皮血管的体表定位.临床应用解剖学杂志, 1984, 2(3): 161-163.
27.	Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg, 1993, 92(3): 421-430.
28.	Nahabedian MY, Patel KM. Maximizing the use of the handheld Doppler in autologous breast reconstruction. Clin Plast Surg, 2011, 38(2): 213-218.
29.	沈琼, 李晓光, 郑丽.彩色多普勒超声在股前外侧皮瓣修复颌面部皮肤软组织缺损中的应用价值.临床超声医学杂志, 2015, 17(11): 755-757.
30.	黄健, 沈毅, 陆林国, 等.应用高频彩超进行股前外侧穿支血管的术前定位与选择.中国口腔颌面外科杂志, 2015, 13(1): 42-47.
31.	Chung YY, Chen MK. Three-dimensional colour Doppler imaging for evaluating perforators of the anterolateral thigh flap. Clin Otolaryngol, 2015. [Epub ahead of print].
32.	Golusiński, Luczewski Ł, Pazdrowski J, et al. The role of colour duplex sonography in preoperative perforator mapping of the anterolateral thigh flap. Eur Arch Otorhinolaryngol, 2014, 271(5): 1241-1247.
33.	Liu SC, Chiu WK, Chen SY, et al. Comparison of surgical result of anterolateral thigh flap in reconstruction of through-and-through cheek defect with/without CT angiography guidance. J Craniomaxillofac Surg, 2011, 39(8): 633-638.
34.	Chiu WK, Lin WC, Chen SY, et al. Computed tomography angiography imaging for the chimeric anterolateral thigh flap in reconstruction of full thickness buccal defect. ANZ J Surg, 2011, 81(3): 142-147.
35.	Boucher F, Moutran M, Boutier R, et al. Preoperative computed tomographic angiography and perforator flaps: a standardization of the protocol. Ann Chir Plast Esthet, 2013, 58(4): 290-309.
36.	Rozen WM, Ashton MW, Pan WR, et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery, 2009, 29(1): 16-23.
37.	朱洪章, 杨有优, 范淼, 等. CT血管造影在旋股外侧动脉3D可视化与穿支体表导航定位中的应用.中华显微外科杂志, 2013, 36(3): 287-291.
38.	唐涛, 周鹏, 王朝晖, 等. CT血管成像三维重建技术在股前外侧穿支皮瓣修复头颈肿瘤术后缺损的应用.中华耳鼻咽喉头颈外科杂志, 2015, 50(5): 383-387.
39.	Chen SY, Lin WC, Deng SC, et al. Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction. Eur J Surg Oncol, 2010, 36(10): 1004-1011.
40.	王德清, 王伯胤, 赵振华, 等.三维增强磁共振血管成像在股前外侧皮瓣移植中的应用价值.温州医学院学报, 2011, 41(6): 534-537.
41.	王欣, 袁中山, 李胜华. MRA在游离组织瓣移植术中临床应用.中国矫形外科杂志, 2008, 16(18): 1406-1407.
42.	赵振华, 杨建峰, 王伯胤, 等. MRA、CTA与DSA在股前外侧皮瓣移植术前应用的对比研究.中华整形外科杂志, 2015, 31(3): 172-175.
43.	蒋春景, 林平, 舒锦尔, 等.三维增强MRA在股前外侧皮瓣术前设计中的应用价值.放射学实践, 2013, 28(7): 788-792.
44.	Chae MP, Hunter-Smith DJ, Rozen WM. Comparative analysis of fluorescent angiography, computed tomographic angiography and magnetic resonance angiography for planning autologous breast reconstruction. Gland Surg, 2015, 4(2): 164-178.
45.	卿黎明, 胡懿郃, 唐举玉, 等.基于数字化技术的腓肠内侧动脉穿支皮瓣血供的三维可视化重建研究.中国修复重建外科杂志, 2014, 28(6): 697-700.
46.	Tang M, Yin Z, Morris SF. A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers. Plast Reconstr Surg, 2008, 122(2): 429-437.
47.	沈美华, 任鹏, 肖虎, 等.基于CT血管造影的胸背动脉三维可视化研究.中国修复重建外科杂志, 2015, 29(3): 326-330.
48.	张元智, 李严兵, 唐茂林, 等.数字化与虚拟现实技术在皮瓣移植中的应用.中华创伤骨科杂志, 2006, 8(6): 501-504.
49.	Shimizu F, Uehara M, Oatari M, et al. Three-dimensional visualization of the human face using DICOM data and its application to facial contouring surgery using free anterolateral thigh flap transfer. J Plast Reconstr Aesthet Surg, 2016, 69(1): e1-4.

1. Lee YC, Chen WC, Chou TM, et al. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications. Plast Reconstr Surg, 2015, 135(4): 1097-1107.
2. Lin CT, Wang CH, Ou KW, et al. Clinical applications of the pedicled anterolateral thigh flap in reconstruction. ANZ J Surg, 2015. [Epub ahead of print].
3. Wei FC, Suominen S, Cheng MH, et al. Anterolateral thigh flap for postmastectomy breast reconstruction. Plast Reconstr Surg, 2002, 110(1): 82-88.
4. Ali RS, Bluebond-Langner R, Rodriguez ED, et al. The versatility of the anterolateral thigh flap. Plast Reconstr Surg, 2009, 124(6 Suppl): e395-407.
5. Lin SJ, Rabie A, Yu P. Designing the anterolateral thigh flap without preoperative Doppler or imaging. J Reconstr Microsurg, 2010, 26(1): 67-72.
6. Luo S, Raffoul W, Luo J, et al. Anterolateral thigh flap: A review of 168 cases. Microsurgery, 1999, 19(5): 232-238.
7. Choi SW, Park JY, Hur MS, et al. An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap. J Craniofac Surg, 2007, 18(4): 866-871.
8. Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg, 2006, 118(4): 928-935.
9. Zachara M, Drozdowski P, Wysocki M, et al. Anatomical variability of the anterolateral thigh flap perforators between sexes: a cadaveric study. Eur J Plast Surg, 2013, 36(3): 179-184.
10. Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2): 571-577.
11. Yildirim S, Gideroglu K, Akoz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg, 2003, 19(4): 225-233.
12. Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck, 2004, 26(9): 759-769.
13. Wolff KD, Holzle F, Kolk A, et al. Suitability of the anterolateral thigh perforator flap and the soleus perforator flap for intraoral reconstruction: a retrospective study. J Reconstr Microsurg, 2011, 27(4): 225-232.
14. Zhang Q, Qiao Q, Yang X, et al. Clinical application of the anterolateral thigh flap for soft tissue reconstruction. J Reconstr Microsurg, 2010, 26(2): 87-94.
15. Seth R, Manz RM, Dahan IJ, et al. Comprehensive analysis of the anterolateral thigh flap vascular anatomy. Arch Facial Plast Surg, 2011, 13(5): 347-354.
16. Kim EK, Kang BS, Hong JP. The distribution of the perforators in the anterolateral thigh and the utility of multidetector row computed tomography angiography in preoperative planning. Ann Plast Surg, 2010, 65(2): 155-160.
17. Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
18. Sananpanich K, Tu YK, Kraisarin J, et al. Flow-through anterolateral thigh flap for simultaneous soft tissue and long vascular gap reconstruction in extremity injuries: anatomical study and case report. Injury, 2008, 39 Suppl 4: 47-54.
19. Shieh SJ, Chiu HY, Yu JC, et al. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2349-2360.
20. Pan SC, Yu JC, Shieh SJ, et al. Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg, 2004, 114(7): 1768-1775.
21. Chou EK, Ulusal B, Ulusal A, et al. Using the descending branch of the lateral femoral circumflex vessel as a source of two independent flaps. Plast Reconstr Surg, 2006, 117(6): 2059-2063.
22. Gao SH, Feng SM, Chen C, et al. A new recipient artery for reconstruction of soft-tissue defects in the lower limb with a free anterolateral thigh flap: the reversed descending branch of the lateral femoral circumflex artery. Plast Reconstr Surg, 2012, 130(5): 1059-1065.
23. Wong CH. The oblique branch trap in the harvest of the anterolateral thigh myocutaneous flap. Microsurgery, 2012, 32(8): 631-634.
24. Wong CH, Goh T, Tan BK, et al. The anterolateral thigh perforator flap for reconstruction of knee defects. Ann Plast Surg, 2013, 70(3): 337-342.
25. Valdatta L, Tuinder S, Buoro M, et al. Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg, 2002, 49(2): 145-150.
26. 高建华, 罗力生, 陈林峰, 等.股前外侧皮瓣主要皮血管的体表定位.临床应用解剖学杂志, 1984, 2(3): 161-163.
27. Koshima I, Fukuda H, Yamamoto H, et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg, 1993, 92(3): 421-430.
28. Nahabedian MY, Patel KM. Maximizing the use of the handheld Doppler in autologous breast reconstruction. Clin Plast Surg, 2011, 38(2): 213-218.
29. 沈琼, 李晓光, 郑丽.彩色多普勒超声在股前外侧皮瓣修复颌面部皮肤软组织缺损中的应用价值.临床超声医学杂志, 2015, 17(11): 755-757.
30. 黄健, 沈毅, 陆林国, 等.应用高频彩超进行股前外侧穿支血管的术前定位与选择.中国口腔颌面外科杂志, 2015, 13(1): 42-47.
31. Chung YY, Chen MK. Three-dimensional colour Doppler imaging for evaluating perforators of the anterolateral thigh flap. Clin Otolaryngol, 2015. [Epub ahead of print].
32. Golusiński, Luczewski Ł, Pazdrowski J, et al. The role of colour duplex sonography in preoperative perforator mapping of the anterolateral thigh flap. Eur Arch Otorhinolaryngol, 2014, 271(5): 1241-1247.
33. Liu SC, Chiu WK, Chen SY, et al. Comparison of surgical result of anterolateral thigh flap in reconstruction of through-and-through cheek defect with/without CT angiography guidance. J Craniomaxillofac Surg, 2011, 39(8): 633-638.
34. Chiu WK, Lin WC, Chen SY, et al. Computed tomography angiography imaging for the chimeric anterolateral thigh flap in reconstruction of full thickness buccal defect. ANZ J Surg, 2011, 81(3): 142-147.
35. Boucher F, Moutran M, Boutier R, et al. Preoperative computed tomographic angiography and perforator flaps: a standardization of the protocol. Ann Chir Plast Esthet, 2013, 58(4): 290-309.
36. Rozen WM, Ashton MW, Pan WR, et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery, 2009, 29(1): 16-23.
37. 朱洪章, 杨有优, 范淼, 等. CT血管造影在旋股外侧动脉3D可视化与穿支体表导航定位中的应用.中华显微外科杂志, 2013, 36(3): 287-291.
38. 唐涛, 周鹏, 王朝晖, 等. CT血管成像三维重建技术在股前外侧穿支皮瓣修复头颈肿瘤术后缺损的应用.中华耳鼻咽喉头颈外科杂志, 2015, 50(5): 383-387.
39. Chen SY, Lin WC, Deng SC, et al. Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction. Eur J Surg Oncol, 2010, 36(10): 1004-1011.
40. 王德清, 王伯胤, 赵振华, 等.三维增强磁共振血管成像在股前外侧皮瓣移植中的应用价值.温州医学院学报, 2011, 41(6): 534-537.
41. 王欣, 袁中山, 李胜华. MRA在游离组织瓣移植术中临床应用.中国矫形外科杂志, 2008, 16(18): 1406-1407.
42. 赵振华, 杨建峰, 王伯胤, 等. MRA、CTA与DSA在股前外侧皮瓣移植术前应用的对比研究.中华整形外科杂志, 2015, 31(3): 172-175.
43. 蒋春景, 林平, 舒锦尔, 等.三维增强MRA在股前外侧皮瓣术前设计中的应用价值.放射学实践, 2013, 28(7): 788-792.
44. Chae MP, Hunter-Smith DJ, Rozen WM. Comparative analysis of fluorescent angiography, computed tomographic angiography and magnetic resonance angiography for planning autologous breast reconstruction. Gland Surg, 2015, 4(2): 164-178.
45. 卿黎明, 胡懿郃, 唐举玉, 等.基于数字化技术的腓肠内侧动脉穿支皮瓣血供的三维可视化重建研究.中国修复重建外科杂志, 2014, 28(6): 697-700.
46. Tang M, Yin Z, Morris SF. A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers. Plast Reconstr Surg, 2008, 122(2): 429-437.
47. 沈美华, 任鹏, 肖虎, 等.基于CT血管造影的胸背动脉三维可视化研究.中国修复重建外科杂志, 2015, 29(3): 326-330.
48. 张元智, 李严兵, 唐茂林, 等.数字化与虚拟现实技术在皮瓣移植中的应用.中华创伤骨科杂志, 2006, 8(6): 501-504.
49. Shimizu F, Uehara M, Oatari M, et al. Three-dimensional visualization of the human face using DICOM data and its application to facial contouring surgery using free anterolateral thigh flap transfer. J Plast Reconstr Aesthet Surg, 2016, 69(1): e1-4.

Chinese Journal of Reparative and Reconstructive Surgery

Reseach development of vascular anatomy and preoperative design technology of anterolateral thigh flap

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content