Anterolateral Thigh Flap
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Indications • • • •
Oral cavity Hemi- and total glossectomy defects Trachea, esophagus, pharynx and skull base Face
Circulation • Septocutaneously by the lateral circumflex femoral artery Constituents • Fasciocutaneous: nerve (lateral femoral cutaneous nerve) Contiguity • Free Construction • Unipedicled • Orthograde flow Conditioning • None Conformation • Fusiform skin island. • The flap can be tubed for pharyngeal reconstruction.
B.M. Erovic, P. Lercher, Manual of Head and Neck Reconstruction Using Regional and Free Flaps, DOI 10.1007/978-3-7091-1172-7_28, © Springer-Verlag Wien 2015
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28 Anterolateral Thigh Flap
The anterolateral thigh flap was first described by Dr. Y.G. Song and co-workers in 1974 and popularized by Dr. Fu-Chan Wei and co-workers in 1994. It is one of the most commonly used flaps for reconstruction of head and neck defects after ablation.
Anatomy Anatomical landmarks for the anterolateral thigh are the anterior superior iliac spine (ASIS) superiorly, the lateral femoral condyle inferiorly, the medial edge of the rectus femoris muscle medially, and the iliopubic tract laterally. Beneath the skin, the superficial fascia which contains a large quantity of fat forms a continuous layer over the thigh and adheres to the deep fascia below the inguinal ligament. The deep fascia or fascia lata extends from the iliac crest laterally and anteriorly, where the tensor fasciae latae muscle is inserted, and courses downward along the thigh, forming the strong iliotibial band which is finally attached to the lateral condyle of the tibia. The fascia lata is thicker in the upper and lateral portion of the thigh than in the middle portion, and becomes strong again around the knee. The function of the fascia lata is to stabilize the knee joint. The tensor fasciae latae muscle (a) (Fig. 28.1) is a small muscle that arises from the ASIS and inserts into the fascia lata. The function of this muscle is to keep the fascia lata under tension and stabilize the knee during extension. The long and narrow sartorius muscle (b) courses from its origin at the ASIS across the anterior thigh to the medial side of the limb and inserts on the medial surface of the proximal tibia. The main function of the sartorius muscle is to enable flexion of the hip and knee. The rectus femoris muscle (c), located in the middle of the thigh, is a fusiform muscle with characteristically superficial bipenniform fibers. The muscle fibers originate from the ASIS, but are also attached to an aponeurosis located on the deep surface of the muscle, extending downward and forming, in the distal aspect, a tendon that inserts at the base of the patella. The rectus femoris muscle is responsible for knee extension and hip flexion. The vastus lateralis muscle (d), located between the rectus femoris muscle and the iliopubic tract, is a part of the quadriceps muscle like the rectus femoris muscle. It arises from the intertrochanteric line, the greater trochanter, the lateral lip of the gluteal tuberosity, and the linea aspera of the femur.
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