Unusual Venous Drainage of A Reverse-Flow Anterolateral Thigh Flap: A Case Report

Abstract

Background: The anterolateral thigh (ALT) flap is a versitile perforator flap. It can be used as a pedicled flap, a reverse flow flap or a free flap. However, thoroug understanding of the anatomic variations of the vascular pedicle of this flap is important for successful flap elevation.Aim: Presenting a case of unusual venous drainge of reverse-flow unterolateral thigh flap. Methods:We report a cases of reverse-flow (ALT) flap with anatomic variation of its venous outflow. During flap elevation, an anomolous vein was found in the intermusclar septum between the vastus lateralis and vastus intermedias muscles. Temporary occlusion of this vein resulted in intraoperative flap congestion. So, we dicided to include this vein with the flap. The flap had two venous systems. The first venous system was the vena comitantes of the descending branch of the lateral circumflex femoral vessles and the second was the anomolus vein which emerged from the vastus intermedius muscle.Results: Postoperative course was unenevtful and the flap survived completely. We did not observe any flap congestion or flap arterial insuficency. Complete wound healing was achieved in 3 weeks. Conclusions:We conclude that this anomolous vein has a significant contribution to the venous outflow of this flap. Meticulous planning and intaraoperative disection is needed for successful elevation of ALT flap.