Perforator vascular anatomy and clinical application of the anteromedial thigh flap for head and neck reconstruction

PURPOSE: A clinical study was undertaken to define the vascular anatomy of anteromedial thigh perforator flap(AMT) and evaluate the outcomes of the flap in head and neck reconstruction. METHODS: The sizable perforators of AMT flaps and their origins were prospectively explored in 54 patients. For each patient, we recorded the sizable perforators' location, diameter, source vessel, numbers and anatomical types. Among them, 14 cases underwent head and neck reconstruction with AMT flaps. The complications and functions of donor and recipient sites were recorded and the operative techniques of AMT were described. Statistical analysis was performed with SPSS 13.0 software package. RESULTS: Eight of fifty-four thighs had no sizable AMT perforators. AMT flap was based on the medial branch of descending branch of lateral circumflex femoral artery(d-LCFA) and shared the same vascular pedicle with anterolateral thigh flap(ALT). The total sizable perforators were 56. Among them, 40.9%(25/61) were direct septocutaneous perforators, the remaining perforators were all musculocutaneous. Most of the sizable perforators(58/61, 95.1%) were located in the middle one-third of the thigh, with an average of(3.9±0.72) cm medial to a line connecting the anterior superior iliac spine and the superolateral patella and an average of(22.5 ±2.38) cm to anterior superior iliac spine. There was an negtive relationship between the number of sizable perforators of AMT and ALT flaps(P 0.01). 14 flaps survived completely. No complications were observed in recipient and donor site. CONCLUSIONS: The pedicle of AMT flap is the medial branch of d-LCFA. The AMT flap may be useful if ALT flap is without sizable perforators. AMT flap may be as a primary or an alternative choice of anterolateral thigh flap for head and neck reconstruction.