Classification and Application of the Distally-Based Thigh Flap Based on the Lateral Circumflex Femoral Artery System

Background: The lateral circumflex femoral artery system with its anatomical variations is a common source vessel for numerous thigh flaps. However, the anatomic variations of the distally based thigh flaps have not been well classified. Methods: Between July 2008 and July 2016, 19 patients (13 men and 6 women; age range, 3–58 years; mean, 27.5 years) underwent reconstruction of defects around the knee using distally based thigh flaps. Defect etiologies included malignant neoplasm (6 cases) and post-burn scar contracture (13 cases). The distally based thigh flaps were raised based on perforating vessels originating from the descending, oblique, rectus femoris branches of the lateral circumflex femoral artery. Results: The average flap size was 17.7 × 8.4 cm (range, 9–24 cm × 6–13 cm), whereas the mean pedicle length was 16.2 cm (range, 8.5–25 cm). The flap's perforating vessels originated from the descending branch in 6 patients, the oblique branch from the descending branch in 7 patients, the rectus femoris branch in 5 patients, and the oblique branch from the transverse branch in 1 patient. All flaps were pedicle flaps except 1 based on the oblique branch from the transverse branch that was converted to a free flap. All flaps survived in its entity. Conclusions: Our experience demonstrated that a distally based thigh flap can be reliably raised using perforating vessels from different branches of the lateral circumflex femoral artery.

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