The Superolateral Thigh Flap: A Reliable Skin Flap Based on the Terminal Cutaneous Branch of the Ascending Branch of the Lateral Circumflex Femoral Artery. Cadaver and Computed Tomography Angiography Studies with a Clinical Series

Introduction: Few are the references to the reconstructive possibilities of the ascending branch of the lateral circumflex femoral artery (LCFA/a) other than the tensor fasciae latae muscle (TFL) flap and the so-called muscle pedicle bone grafting technique. Since the introduction of perforator-based tissue transfer, the computed tomography angiography (CTA) has emerged as a valuable technique in preoperative planning of perforator flaps. Methodology and Material: Evaluate the LCFA/a and its contribution, through direct branches, to the skin and iliac crest. Evaluate the surgeon’s performance in the post-processing of DICOM images with the free open-source OsiriX application. Materials and Methods: An anatomical research (computed tomography angiography and cadaver dissection) was performed to evaluate the LCFA/a and its contribution, through direct branches, to the iliac crest and skin. Results: In 9/20 of dissections, a small branch of LCFA/a was found to reach the iliac crest in the space defined by rectus femoris, gluteal muscles and TFL. After the emergence of the TFL pedicle, the LCFA/a coursed through an anatomical triangular space before entering the trochanteric skin as a direct terminal branch and running for a considerable distance in a posterior-inferior direction in the subcutaneous fat. This pretrochanteric triangle was defined by the TFL, the trochanteric insertions of vastus lateralis and gluteus medius muscles and the greater trochanter. Based on these findings, a clinical series with four free skin flap transfers was undertaken. Conclusions: The superolateral skin of the thigh can be transferred based on terminal branches of LCFA/a. Although inconstant, a small branch of LCFA/a reaches the iliac crest and might support vascularized bone transfer although more studies are needed to define its role in composite tissue transplantation. With adequate patient selection, the LCFA/a might be a good alternative in pedicle or microvascular skin/fat transfer, breast reconstruction, tendocutaneous reconstructions or composite tissue transplantation.