Anterolateral thigh free flap
Considerations
Preparation
Procedure
Mark the axis of the surface of the septum between the rectus femoris and the vastus lateralis is with a line connecting the anterior superior iliac spine and the lateral patella
Divide this line into thirds for purposes of outlining the flap
Doppler and mark the perforators
Design the flap, including
The junction of the proximal and middle third
Often the site of a perforator that pierces the tensor fascia lata, which may be critical if the distal perforators are of poor quality or injured
The junction of the middle and distal third is marked and is also incorporated into the flap
Incise anteriorly
Elevate the anterior flap toward the septum
Preserve perforators through the rectus femoris
Incise posteriorly
Elevate the posterior flap
Preserve perforators through the vastus lateralis
Dissect the inferior perforator toward the descending branch of the lateral circumflex femoral artery
Identify the septum and septal perforators
Determine the vital perforators
If the perforators are trans-septal, identify the descending branch of the LCFA between the RF and VL muscles and dissect proximally
If the perforators are trans-muscular, dissect through muscle to the descending branch of the LCFA and dissect proximally
Dissect the pedicle proximally
Harvest the flap
Closure
Raise subcutaneous flaps medially and laterally superficial to the fascia
Place a JP drain
Approximate with deep buried interrupted 3-0 Polysorb
Approximate the skin
Dressing
Sample operative report