The Innervated Anterolateral Thigh Flap: Anatomical Study and Clinical Implications

Abstract

During the past 20 years, the neural anatomy of many flaps has been investigated, although no extensive studies have been reported yet on the anterolateral thigh flap. The goal of this study was to describe the sensory territories of the nerves supplying the anterolateral thigh flap with dissections on fresh cadavers and with local anesthetic injections in living subjects. The sensate anterolateral thigh flap is typically described as innervated by the lateral cutaneous femoral nerve. Two other well-known nerves, the superior perforator nerve and the median perforator nerve, which enter the flap at its medial border, might have a role in anterolateral thigh flap innervation. Twenty-nine anterolateral thigh flaps were elevated in 15 cadavers, and the lateral cutaneous femoral nerve, the superior perforator nerve, and median perforator nerve were dissected. In the injection study, the lateral cutaneous femoral nerve, superior perforator nerve, and median perforator nerve in 16 thighs of eight subjects were sequentially blocked. The resulting sensory deficit from each injection was mapped on the skin and superimposed on the marked anterolateral thigh flap territory. The study shows that the sensate anterolateral thigh flap is basically innervated by all three nerves. The lateral cutaneous femoral nerve was present in 29 of 29 thighs, whereas the superior perforator nerve was present in 25 of 29 and the median perforator nerve in 24 of 29 thighs. Furthermore, in the proximal half of the flap, the lateral cutaneous femoral nerve lies deep, whereas the superior perforator nerve and median perforator nerve lie more superficially. Whereas the lateral cutaneous femoral nerve innervates the entire flap, the superior perforator nerve innervates 25 percent of the flap and the median perforator nerve innervates 60 percent of the flap. Clinically, a small anterolateral thigh flap (7 x 5 cm) can be raised sparing the lateral cutaneous femoral nerve and using only the selective areas innervated by the superior perforator and median perforator nerves. Alternatively, a large anterolateral thigh flap can be raised with this multiple innervation. This can be helpful if one wants to harvest the flap under local anesthesia. Sensate bilobed flaps can be harvested when dual innervated flaps are required.

Lambeaux perforants fins prélevés dans le plan du fascia superficialis : principe et technique opératoire

“…La complication la plus fréquente observée après l'utilisation d'un lambeau antérolateral de cuisse reste la paresthésie de la face latérale de la cuisse [15]. Lors du prélèvement dans le plan du fascia superficialis, l'épargne nerveuse sensitive se fait automatiquement car le plan de dissection se trouve au-dessus du nerf [8] (Fig. 3).…”

“…Les branches se distribuant dans la graisse profonde sont cautérisées ou ligaturées pour individualiser la perforante sur les seules branches superficielles. Le nerf cutané latéral de la cuisse, situé sous le fascia superficialis à cette hauteur [8], peut ainsi être aisément préservé. (Fig.…”

Colgajo anterolateral del muslo: anatomía quirúrgica, técnica de disección y aplicaciones clínicas

“…También presenta la ventaja de ser un colgajo potencialmente sensitivo siempre y cuando se conserve alguna rama del nervio cutáneo femoral lateral y se pueda anastomosar en la zona receptora (17). El pedículo de este colgajo puede ser considerable, alcanzando los 18-20 cm.…”

“…Kimata obtuvo buenos resultados en 8 casos (16). Otros 2 nervios contribuyen en menor medida a la sensibilidad de este colgajo, el nervio perforante superior y el nervio perforante medial (17).…”

Grenzen und Möglichkeiten der Vermeidung von Majoramputationen der unteren Extremität bei Diabetischem Fußsyndrom und arterieller Verschlusskrankheit durch freien Gewebetransfer

“…Die sensible Versorgung dieser Lappenplastik erfolgt durch den N. cutaneus fem. lateralis [37] . Jedoch ist der Vorteil bei Patienten mit diabetischem Fu ß syndrom mit fortgeschrittener Polyneuropathie nicht zu erwarten und wird von einigen Autoren auch nicht empfohlen [16,17] .…”