Vascular anatomy and clinical application of anterolateral leg perforator flaps

There is a dearth of detailed published work on anterolateral leg perforators. The authors fully documented the vascular basis of the anterolateral leg perforator flap and report its use in reconstruction of distal extremities.

Anterolateral leg perforators were investigated in 25 fresh cadavers and 10 casts of arteries. Fresh cadavers were injected with a standardized injection of lead oxide for three-dimensional visualization reconstruction using multidetector-row computed tomography and professional software. The origin, course, and distribution of the perforators in the anterolateral leg region were observed. Between March of 2008 and March of 2012, 15 free superficial peroneal artery perforator flaps were used for reconstruction of distal limbs. Flap size varied from 3.5 × 4.0 cm to 11 × 5 cm, with a uniform thickness of 3 mm.

There were 7 ± 3.0 perforators in the anterolateral leg. The average external diameter was 0.7 ± 0.2 mm. Each perforator supplied an average area of 33 ± 8.0 cm. Extensive anastomoses were found between the superficial peroneal artery perforators and multiple adjacent source arteries. All cases were repaired successfully without any complications. The clinical results were satisfactory after 3 to 12 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors.

The anterolateral leg perforator flaps have a consistent, reliable blood supply and good texture. The donor site not only supplies a thin skin flap but also provides the option of harvesting cross-boundary proximally or distally based perforator flaps that could be useful for repairing widespread traumatic soft-tissue defects.