ABSTRACT
The anterolateral thigh flap is a perforator flap (Figure 3.10.1). A perforator flap is a flap of skin or subcutaneous tissue that is based on the dissection of a perforating vessel. A perforating vessel or, in short, a perforator, is a vessel that has its origin in one of the axial vessels of the body. It passes through certain structural elements of the body besides interstitial connective tissue and fat before reaching the subcutaneous fat layer. As a perforator flap, the anterolateral thigh flap is relatively simple to raise and in most hands has been reported as an extremely reliable flap for a variety of defects. If the flap pedicle is harvested at its junction with the profunda vessels, the artery is typically 4 mm in diameter and the vein 6 mm in diameter, and it is extremely long. The lateral cutaneous nerve can be incorporated for either motor or sensory nerve reconstruction. Like most perforator flaps it has the advantage of not removing a bulk of muscle and of the skin being closed primarily. It can be raised as a free myocutaneous flap and, provided a large enough flap is raised, the distribution of perforators can be ignored. However, in a Western population, the added bulk is seldom necessary and there are better alternatives if this is desired.
