title: Surgical implications of anatomical variation in anterolateral thigh flaps for the reconstruction of oral and maxillofacial soft tissue defects: focus on perforators and pedicles.
abstract: OBJECTIVE
  To gain information on anatomical variation in anterolateral thigh (ALT) flaps in a series of clinical cases, with special focus on perforators and pedicles, for potential use in reconstruction of oral and maxillofacial soft tissue defects.
  
  
  METHODS
  Eight patients who underwent microvascular reconstructive surgery with ALT free flaps after ablative surgery for oral cancer were included. The number of perforators included in cutaneous flaps, location of perforators (septocutaneous or musculocutaneous), and the course of vascular pedicles were intraoperatively investigated.
  
  
  RESULTS
  Four cases with a single perforator and four cases with multiple perforators were included in the ALT flap designed along the line from anterior superior iliac spine to patella. Three cases had perforators running the septum between the vastus lateralis and rectus femoris muscle (septocutaneous type), and five cases had perforators running in the vastus lateralis muscle (musculocutaneous type). Regarding the course of vascular pedicles, five cases were derived from the descending branch of the lateral circumflex femoral artery (type I), and three cases were from the transverse branch (type II).
  
  
  CONCLUSIONS
  Anatomical variation affecting the distribution of perforators and the course of pedicles might prevent use of an ALT free flap in various reconstruction cases. However, these issues can be overcome with an understanding of anatomical variation and meticulous surgical dissection. ALT free flaps are considered reliable options for reconstruction of soft tissue defects of the oral and maxillofacial area.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea.
authors.forename: Ji-Wan
authors.identifier: 0000-0001-7761-0649
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea.
authors.forename: Dong-Young
authors.identifier: 0000-0002-2772-2519
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea.
authors.forename: Kang-Min
authors.identifier: 0000-0003-1215-5643
authors.initials: KM
authors.lastname: Ahn
authors.affiliation: Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea.
authors.forename: Jee-Ho
authors.identifier: 0000-0003-4232-2756
authors.initials: JH
authors.lastname: Lee
keywords: Anterolateral thigh flap; Perforator; Vascular pedicle