title: Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications.
abstract: BACKGROUND
  Anatomical variability of perforators of the anterolateral thigh flap has been reported. The authors introduce a classification based on the number, location, and origin of the cutaneous perforators to comprehensively illustrate their vascular patterns in hopes that unfavorable anatomical variations of the anterolateral thigh flap can be overcome in clinical applications.
  
  
  METHODS
  The authors enrolled and reviewed 110 anterolateral thigh flaps created between September of 2010 and January of 2013 for head and neck reconstruction after cancer ablation. The location of the perforators was defined by Yu's ABC system. Its corresponding origin from the descending or transverse branch of the lateral circumflex femoral artery was clarified by Shieh's vascular anatomical classification for the anterolateral thigh flap.
  
  
  RESULTS
  Of the 110 flaps, a single perforator (A or B or C) was observed in 20 flaps (18.2 percent), double perforators (A + B or B + C or A + C) were observed in 59 flaps (53.6 percent), and triple perforators (A + B + C) in 31 flaps (28.2 percent). The origin of perforators was the descending branch in 76 flaps (69.1 percent), the transverse branch in 10 flaps (9.1 percent), and both descending and transverse branches in 24 flaps (21.8 percent). The authors observed 16 vascular patterns. The most common type was double perforators, with perforators B and C originating from the descending branch [n = 40 (36.4 percent)].
  
  
  CONCLUSIONS
  The clinical significance of each pattern is delineated, and surgical technical considerations are suggested according to flap requirements and types of vascular anatomy.
authors.affiliation: Tainan, Taiwan From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute of Clinical Medicine, National Cheng Kung University Medical College and Hospital; and the International Research Center for Wound Repair and Regeneration (iWRR), National Cheng Kung University.
authors.forename: Yao-Chou
authors.initials: YC
authors.lastname: Lee
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Chen
authors.forename: Ting-Mao
authors.initials: TM
authors.lastname: Chou
authors.forename: Shyh-Jou
authors.initials: SJ
authors.lastname: Shieh
mesh_terms: D063405:Anatomic Variation; D005260:Female; D006801:Humans; D008297:Male; D061525:Perforator Flap / Q000098:blood supply*; D013848:Thigh / Q000098:blood supply*