title: The extended approach to the vascular pedicle of the anterolateral thigh perforator flap: anatomical and clinical study.
abstract: BACKGROUND
  The anterolateral thigh perforator flap is a well-described and versatile flap that has specific advantages. However, the variable anatomy makes flap elevation challenging. Furthermore, the dissection of the proximal part of the pedicle that runs underneath the rectus femoris muscle demands continuous pull by an assistant and is inconvenient and tiring for the surgeon. A technique that facilitates dissection of the proximal pedicle part is suggested. It is useful in both pedicled and free flap transfer, when maximum pedicle length is crucial.
  
  
  METHODS
  Five anterolateral thigh perforator flaps were dissected using the extended technique. Four were transferred as free flaps and one as an island pedicled flap. In addition, anatomical cadaver studies were performed bilaterally in five fresh cadavers to further clarify the relevant anatomy.
  
  
  RESULTS
  All flaps survived well. One patient suffered from donor-site infection caused by inadequate drainage. Conservative treatment with daily dressing changes resulted in satisfactory healing. Two patients suffered from hypesthesia of part of the lateral thigh area. No patient experienced any difficulty in daily activities and none suffered from knee extension lag.
  
  
  CONCLUSIONS
  An extended approach for dissection of the anterolateral thigh perforator flap is described that is useful in both pedicled and free flap transfers. Cautious tunnel creation is a prerequisite for avoidance of complications.
authors.affiliation: Plastic Surgery Department, NIMTS Veteran's Hospital, Athens, Greece. spyriounis@internet.gr
authors.forename: Petros K
authors.initials: PK
authors.lastname: Spyriounis
mesh_terms: D004210:Dissection / Q000379:methods*; D005267:Femoral Nerve / Q000033:anatomy & histology; D006801:Humans; D018482:Muscle, Skeletal / Q000098:blood supply / Q000294:innervation; D013524:Surgical Flaps / Q000098:blood supply / Q000294:innervation; D013848:Thigh / Q000098:blood supply / Q000294:innervation