Colour Doppler Assessment of the Perforators of Anterolateral Thigh Flap and its Usefulness in Preoperative Planning

Abstract

The role of the anterolateral thigh flap (ALTF) in reconstructive microsurgery grows systematically from mid-eighties of the twenty century until now. Significant anatomic variability of the perforators supplying the ALTF was described in literature. THE AIM OF THE STUDY was ultrasonographic assessment of the ALTF perforators in terms of localization, symmetry, diameter and flow velocity. The study was performed using ultrasound machine with 12 MHz linear transducer. Both thighs of 30 healthy volunteers (15 men and 15 women) aged from 18 to 60 (mean 37.9) were examined. The line from anterior superior iliac spine (ASIS) to lateral border of the patella was traced, and divided into 10 equal segments. Point where perforator pierces the deep fascia was marked and its diameter was measured and recorded. Maximal flow velocity was measured and recorded. Symmetry of perforator location was confirmed as positive if difference in position of two perforators on both thighs was less than 1.5 cm in diameter. Total number of 119 perforators supplying skin of 60 thighs was found (mean 1.98 perforator per thigh). No perforators were found in 4 thighs (6.6%). Perforators were most abundant in segments from 5 to 7 (74.6%). Perforators with largest diameters and maximal flow velocity reaching 30-47 cm/s were localized in segments 5 and 6. Perforators in segments 4 and 5 were more abundant in men (50.9%) than in women (36.7%). Septal perforators make up to 26.9% of the total. Eighty percent of the septal perforators were localized in segments 5 and 6. Perforator distribution was elicited in the middle of the ASIS--patella line. In the range of ±1.5 cm from the midpoint of the line 33.6% of the perforators were found. 1. Most of perforators with large diameter and big flow velocity are located in segments 5 and 6. 2. Perforators are more common in men in segments 4 and 5 than in women. 3. No perforators found in 4 thighs suggests that preoperative perforator mapping should become a preoperative routine, which can spare intraoperative dilemmas.