Anatomical variability of the anterolateral thigh flap perforators between sexes: a cadaveric study

BACKGROUND: Anterolateral thigh flap (ALTF) has gain popularity as a workhorse flap in the management of simple as well as complex tissue defects. The purpose of this study was to investigate the differences in ALTF's perforators' location in male and female human cadavers. METHODS: The study involved 30 fresh human cadavers of both sexes. A total of 60 flaps were examined. The flaps were raised as originally designed. After location of vessels, the distance from the anterior superior iliac spine (ASIS) to subsequent perforators was measured. Also, the kind of the perforator, its diameter and origin were marked. Perforators were designated according to Yu's classification (A, B, and C). The perforators were divided into thin (<0.5 mm), medium (0.5-1 mm), and thick (>1 mm). Ratio of the ASIS-patella distance to the distance of a given perforator from the ASIS (AP rate) was calculated. RESULTS: The mean AP rate (perforator location) was different in both sexes. Mean AP rate in men was calculated as 0.498 ± 0.117, and in women, 0.559 ± 0.114. Differences in AP rate between female and male were statistically significant (t = -3.144; p < 0.002). Mean flap thickness was 3.65 cm in women and 1.17 cm in men (t = -14.444; p < 0.00001). In men, 63 perforators originated from descending branch, and seven perforators originated from oblique branch. In women, there were 67 and one, respectively. CONCLUSIONS: In men, perforators are located closer to the ASIS in comparison to women. Clinically significant perforators (Φ > 0.5 mm), in majority of cases, occur in A and B positions. Thickness of the flap was higher in women. The oblique branch was more common in men.