Song 1984 - BJPS - ALT

Summary

This 1984 article by Song, Chen, and Song describes the free thigh flap, a new type of free flap for reconstructive surgery based on the septocutaneous artery concept. The authors discuss the anatomy, operative technique, and characteristics of three types of thigh flaps: the anterolateral, anteromedial, and posterior thigh flaps.

The arterial supply for the anterolateral thigh flap comes from the descending branch of the lateral femoral circumflex artery, which emerges at the junction of the rectus femoris, vastus lateralis, and tensor fasciae latae muscles. This pedicle is typically over 2mm diameter and 8cm long. The anteromedial flap is supplied by an innominate branch of the lateral circumflex femoral artery or a muscular branch to the sartorius and gracilis muscles. The posterior flap is based on the third perforating artery of the profunda femoris. Each flap has accompanying veins and nerves that can also be used.

The thigh flaps have several advantages over conventional flaps like groin and abdominal flaps:

• Easily raised on a hidden donor site. The vascular pedicles are long, large caliber, and constant.

• The skin quality is good for facial and neck reconstruction.

• Flaps of irregular shape and large size can be raised as needed.

• The long vascular pedicle facilitates flap transfer and improves success rate.

• The pedicle is reliable and can be explored, revised if needed after transfer.

The operative technique involves preoperative planning with a Doppler probe to identify the vascular pedicle. After raising the flap, 1 cm of septal tissue around the pedicle is taken to improve blood flow from ligation of muscular branches. Venous drainage must be meticulous, using the concomitant veins rather than superficial veins. Recipient vessel preparation is done concurrently.

The authors report excellent blood supply and success in 15 free thigh flap transfers for head and neck burn contractures, though secondary thinning was required due to flap bulk. They conclude the thigh flap offers advantages over inguinal and abdominal flaps, as well as standard thigh myocutaneous flaps by providing a sensate fasciocutaneous flap with more flexibility.

In summary, this influential historical article introduced the thigh as a new donor site for free tissue transfer and detailed the anatomy and clinical application of fasciocutaneous flaps based on the septocutaneous arteries of the thigh region. The anterolateral thigh flap in particular would become a workhorse flap for head and neck reconstruction.