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：

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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.	高建華, 羅力生, 陳林峰, 等.股前外側皮瓣主要皮血管的體表定位.臨床應用解剖學雜志, 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.	沈瓊, 李曉光, 鄭麗.彩色多普勒超聲在股前外側皮瓣修復頜面部皮膚軟組織缺損中的應用價值.臨床超聲醫學雜志, 2015, 17(11): 755-757.
30.	黃健, 沈毅, 陸林國, 等.應用高頻彩超進行股前外側穿支血管的術前定位與選擇.中國口腔頜面外科雜志, 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 ?, 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, 楊有優, 范淼, 等. CT血管造影在旋股外側動脈3D可視化與穿支體表導航定位中的應用.中華顯微外科雜志, 2013, 36(3): 287-291.
38.	唐濤, 周鵬, 王朝暉, 等. CT血管成像三維重建技術在股前外側穿支皮瓣修復頭頸腫瘤術后缺損的應用.中華耳鼻咽喉頭頸外科雜志, 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, 趙振華, 等.三維增強磁共振血管成像在股前外側皮瓣移植中的應用價值.溫州醫學院學報, 2011, 41(6): 534-537.
41.	王欣, 袁中山, 李勝華. MRA在游離組織瓣移植術中臨床應用.中國矯形外科雜志, 2008, 16(18): 1406-1407.
42.	趙振華, 楊建峰, 王伯胤, 等. MRA、CTA與DSA在股前外側皮瓣移植術前應用的對比研究.中華整形外科雜志, 2015, 31(3): 172-175.
43.	蔣春景, 林平, 舒錦爾, 等.三維增強MRA在股前外側皮瓣術前設計中的應用價值.放射學實踐, 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, 唐舉玉, 等.基于數字化技術的腓腸內側動脈穿支皮瓣血供的三維可視化重建研究.中國修復重建外科雜志, 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.	沈美華, 任鵬, 肖虎, 等.基于CT血管造影的胸背動脈三維可視化研究.中國修復重建外科雜志, 2015, 29(3): 326-330.
48.	張元智, 李嚴兵, 唐茂林, 等.數字化與虛擬現實技術在皮瓣移植中的應用.中華創傷骨科雜志, 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. 高建華, 羅力生, 陳林峰, 等.股前外側皮瓣主要皮血管的體表定位.臨床應用解剖學雜志, 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. 沈瓊, 李曉光, 鄭麗.彩色多普勒超聲在股前外側皮瓣修復頜面部皮膚軟組織缺損中的應用價值.臨床超聲醫學雜志, 2015, 17(11): 755-757.
30. 黃健, 沈毅, 陸林國, 等.應用高頻彩超進行股前外側穿支血管的術前定位與選擇.中國口腔頜面外科雜志, 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 ?, 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, 楊有優, 范淼, 等. CT血管造影在旋股外側動脈3D可視化與穿支體表導航定位中的應用.中華顯微外科雜志, 2013, 36(3): 287-291.
38. 唐濤, 周鵬, 王朝暉, 等. CT血管成像三維重建技術在股前外側穿支皮瓣修復頭頸腫瘤術后缺損的應用.中華耳鼻咽喉頭頸外科雜志, 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, 趙振華, 等.三維增強磁共振血管成像在股前外側皮瓣移植中的應用價值.溫州醫學院學報, 2011, 41(6): 534-537.
41. 王欣, 袁中山, 李勝華. MRA在游離組織瓣移植術中臨床應用.中國矯形外科雜志, 2008, 16(18): 1406-1407.
42. 趙振華, 楊建峰, 王伯胤, 等. MRA、CTA與DSA在股前外側皮瓣移植術前應用的對比研究.中華整形外科雜志, 2015, 31(3): 172-175.
43. 蔣春景, 林平, 舒錦爾, 等.三維增強MRA在股前外側皮瓣術前設計中的應用價值.放射學實踐, 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, 唐舉玉, 等.基于數字化技術的腓腸內側動脈穿支皮瓣血供的三維可視化重建研究.中國修復重建外科雜志, 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. 沈美華, 任鵬, 肖虎, 等.基于CT血管造影的胸背動脈三維可視化研究.中國修復重建外科雜志, 2015, 29(3): 326-330.
48. 張元智, 李嚴兵, 唐茂林, 等.數字化與虛擬現實技術在皮瓣移植中的應用.中華創傷骨科雜志, 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

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