ANATOMICAL COMPARISON AMONG THE ANTEROLATERAL THIGH, THE PARASCAPULAR, AND THE LATERAL ARM FLAPS FABIO F. BUSNARDO, M.D., Ph.D., PEDRO S. COLTRO, M.D., Ph.D.,* MARCELO V. OLIVAN, M.D., Ph.D., JOSE C. FAES, M.D., Ph.D., ELIZEU LAVOR, M.D., MARCUS C. FERREIRA, M.D., Ph.D., ALDO J. RODRIGUES Jr., M.D., Ph.D., and ROLF GEMPERLI, M.D., Ph.D.
Objective: This study aims to compare the major anatomical aspects among anterolateral thigh, parascapular and lateral arm flaps. Methods: Sixty flaps were dissected in 20 human cadavers, comparing their vascular pedicle length, flap thickness and arterial/venous pedicle diameters. Results: The vascular pedicle length (from the origin of the vascular pedicle to its entry into the skin flap) of anterolateral thigh flap (13.43 6 3.92 cm, lateral circumflex femoral artery) was longer than parascapular (9.07 6 1.20 cm, circumflex scapular artery) and lateral arm flap (8.90 6 1.65 cm, posterior collateral radial artery) (P < 0.001). The thickness of lateral arm flap (6.32 6 2.33 mm) was lesser than parascapular (8.59 6 2.93 mm) and anterolateral thigh flap (9.30 6 3.54 mm) (P < 0.001). The arterial/ venous pedicle diameters of lateral arm flap (2.37 6 0.69 mm / 2.61 6 0.74 mm) were lesser than parascapular (3.46 6 0.80 mm / 4.07 6 0.87 mm) and anterolateral thigh flap (3.26 6 0.74 mm / 3.87 6 0.70 mm) (P < 0.001). Conclusions: The vascular pedicle length of anterolateral thigh flap was the longest and that lateral arm flap presented a pedicle with the smallest arterial and venous diameters, in C 2014 Wiley Periodicals, Inc. Microsurgery 35:387–392, 2015. addition to being the thinnest flap. V
The
first report on the literature related to skin flaps based on perforator vessels was made by Kroll and Rosenfield in 1988, using flaps vascularized by perforator muscle vessels from lumbar and sacral region.1 The anterolateral thigh perforator flap is vascularized by perforator vessels from the lateral circumflex femoral artery.2 It has some advantages in reconstructive surgeries, like a thin skin paddle, a long and large vascular pedicle and low donor site morbidity, which can be closed primarily.3 However, the dissection of the intramuscular path of its pedicle, presented in the most of patients, can be technically difficult. Its indication for reconstructive surgery and microsurgery is sometimes questionable since it has characteristics similar to other flaps based on direct cutaneous or septocutaneous vessels, which have less anatomical variations and are easier to dissect.4 For example, the parascapular flap and the lateral arm flap are commonly used for reconstructive surgery and also are related to low donor site morbidity. The parascapular flap is vascularized by circumflex scapular artery and the lateral arm flap is vascularized by the posterior collateral radial artery. Both flaps have a constant vascular anatomy and a thin skin paddle, with a vascular pedicle easy to dissect and vessels with satisfactory diameter and length.5,6
~o Paulo, University Division of Plastic Surgery and the Cancer Institute of Sa ~o Paulo School of Medicine, Sa ~o Paulo, Brazil of Sa *Correspondence to: Pedro Soler Coltro, M.D., Ph.D., Alameda Jauaperi 943 polis, Sa ~o Paulo, Brazil. E-mail: [email protected] apto 172, Indiano Received 20 June 2014; Revision accepted 5 November 2014; Accepted 10 November 2014 Published online 23 November 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/micr.22357 Ó 2014 Wiley Periodicals, Inc.
The anterolateral thigh, the parascapular and the lateral arm flaps have been commonly used as free flaps in head and neck reconstructions and in other areas.7–10 In 2013, Klinkenberg et al. compared donor-site morbidity, aesthetic and functional outcomes among these three flaps, but their morphological aspects were not analyzed.11 We could not find any comparative study about anatomical characteristics of these flaps. We believe that anatomical studies may help plastic surgeons to emphasize the differences among the anterolateral thigh, the parascapular and the lateral arm flaps. The purpose of this study is to compare the major anatomical features among these three flaps. MATERIALS AND METHODS
Sixty flaps were dissected (20 anterolateral thigh, 20 parascapular, and 20 lateral arm flaps) in 20 human fresh cadavers, not perfused with formaldehyde,
Objective: This study aims to compare the major anatomical aspects among anterolateral thigh, parascapular and lateral arm flaps. Methods: Sixty flaps were dissected in 20 human cadavers, comparing their vascular pedicle length, flap thickness and arterial/venous pedicle diameters. Results: The vascular pedicle length (from the origin of the vascular pedicle to its entry into the skin flap) of anterolateral thigh flap (13.43 6 3.92 cm, lateral circumflex femoral artery) was longer than parascapular (9.07 6 1.20 cm, circumflex scapular artery) and lateral arm flap (8.90 6 1.65 cm, posterior collateral radial artery) (P < 0.001). The thickness of lateral arm flap (6.32 6 2.33 mm) was lesser than parascapular (8.59 6 2.93 mm) and anterolateral thigh flap (9.30 6 3.54 mm) (P < 0.001). The arterial/ venous pedicle diameters of lateral arm flap (2.37 6 0.69 mm / 2.61 6 0.74 mm) were lesser than parascapular (3.46 6 0.80 mm / 4.07 6 0.87 mm) and anterolateral thigh flap (3.26 6 0.74 mm / 3.87 6 0.70 mm) (P < 0.001). Conclusions: The vascular pedicle length of anterolateral thigh flap was the longest and that lateral arm flap presented a pedicle with the smallest arterial and venous diameters, in C 2014 Wiley Periodicals, Inc. Microsurgery 35:387–392, 2015. addition to being the thinnest flap. V
The
first report on the literature related to skin flaps based on perforator vessels was made by Kroll and Rosenfield in 1988, using flaps vascularized by perforator muscle vessels from lumbar and sacral region.1 The anterolateral thigh perforator flap is vascularized by perforator vessels from the lateral circumflex femoral artery.2 It has some advantages in reconstructive surgeries, like a thin skin paddle, a long and large vascular pedicle and low donor site morbidity, which can be closed primarily.3 However, the dissection of the intramuscular path of its pedicle, presented in the most of patients, can be technically difficult. Its indication for reconstructive surgery and microsurgery is sometimes questionable since it has characteristics similar to other flaps based on direct cutaneous or septocutaneous vessels, which have less anatomical variations and are easier to dissect.4 For example, the parascapular flap and the lateral arm flap are commonly used for reconstructive surgery and also are related to low donor site morbidity. The parascapular flap is vascularized by circumflex scapular artery and the lateral arm flap is vascularized by the posterior collateral radial artery. Both flaps have a constant vascular anatomy and a thin skin paddle, with a vascular pedicle easy to dissect and vessels with satisfactory diameter and length.5,6
~o Paulo, University Division of Plastic Surgery and the Cancer Institute of Sa ~o Paulo School of Medicine, Sa ~o Paulo, Brazil of Sa *Correspondence to: Pedro Soler Coltro, M.D., Ph.D., Alameda Jauaperi 943 polis, Sa ~o Paulo, Brazil. E-mail: [email protected] apto 172, Indiano Received 20 June 2014; Revision accepted 5 November 2014; Accepted 10 November 2014 Published online 23 November 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/micr.22357 Ó 2014 Wiley Periodicals, Inc.
The anterolateral thigh, the parascapular and the lateral arm flaps have been commonly used as free flaps in head and neck reconstructions and in other areas.7–10 In 2013, Klinkenberg et al. compared donor-site morbidity, aesthetic and functional outcomes among these three flaps, but their morphological aspects were not analyzed.11 We could not find any comparative study about anatomical characteristics of these flaps. We believe that anatomical studies may help plastic surgeons to emphasize the differences among the anterolateral thigh, the parascapular and the lateral arm flaps. The purpose of this study is to compare the major anatomical features among these three flaps. MATERIALS AND METHODS
Sixty flaps were dissected (20 anterolateral thigh, 20 parascapular, and 20 lateral arm flaps) in 20 human fresh cadavers, not perfused with formaldehyde,
