Effect of peripheral vascular disease on the blood supply of the anterolateral thigh free flap: a radiographic study.

BACKGROUND

The anterolateral thigh flap has gained popularity over the last few decades for the reconstruction of various surgical defects. The anatomy of the main perforating vessel of the anterolateral flap, the descending branch of the lateral circumflex femoral artery (dbLCFA), has been well described in the literature, however only one study has investigated its patency in patients with significant comorbidities. The aim of this study is to assess the degree of vascular stenosis of the dbLCFA in patients with multiple comorbidities.

PATIENTS AND METHODS

A total of 128 sets of angiographic data were collected from 93 patients retrospectively over a 12-month period. The percentage stenosis of superficial femoral artery (SFA), LCFA, and dbLCFA was measured and converted into an established scoring system.

RESULTS

The rate of dbLCFA stenosis was 12.5%. Interestingly, 24.0% of patients without peripheral vascular disease (PVD) showed some degree of stenotic changes in the dbLCFA, whereas only 10.7% of those with PVD had some degree of stenosis. There was no correlation between dbLCFA stenosis and patient comorbidity. The SFA was significantly affected by smoking, hypercholesterolemia (p < 0.05), and diabetes mellitus (p < 0.01) CONCLUSIONS: This study shows that the dbLCFA is not affected by patient comorbidity including PVD when compared with medically fit controls. Even in individuals with severe disease of the superficial vascular system; there is often sparing of the deep system. Surgical reconstruction using the anterolateral thigh flap is a safe procedure for patients even with multiple comorbidities including significant PVD and no additional preoperative investigations are required.