Lateral Circumflex Femoral Artery System as a Universal Free Flap Donor Area

Introduction: Anterolateral thigh (ALT) flap based on the lateral circumflex femoral artery (LCFA) system has become the ”universal” donor area for many surgeons. It has become by the most utilized donor area for many centers. Many modifications and indications have been described. We present our experience with this versatile donor area, with more modifications and indications than described in the literature.

Methodology and Material: 116 consecutive flaps from the LCFA system were performed in 114 patients (age range 6-85 years). Location of the defects were; 81 head and neck, 29 lower extremity and 6 upper extremity reconstructions. Flaps were; 42 ALT perforator, 61 vastus lateralis (VL) myocutaneous, 8 vastus lateralis muscle, 2 tensor fascia lata perforator, and 3 ALT/VL with vastus intermedius muscle and femur bone. Etiologies ranged from cancer of the head and neck, open long bone fractures, gunshot wounds, osteoradinecrosis, burns, fistulas and congenital and benign tumors.

Results: The size of flaps ranged from 4x7cm to 17x28cm. There were 3(2.6%) total flap failures, all of which were lower extremity. There was 1(0.8%) partial flap loss. Several technical modifications and versatilities included tissue expansion before flap harvest, chimeric flaps, nerve coaptation for sensation, flap thinning, complete deepithalization, inclusion of fascia lata for functional tendon reconstruction, flow-thru anastomosis, segmental and muscle sparing harvest and inclusion of bone. Forty seven patients required skin grafting for donor area closure. None indicated weakness at ambulation in long term follow up.

Conclusions: Lateral circumflex femoral artery system offers familiar anatomy, easy positioning, two-team surgery, fast flap harvest, low morbidity. Tissues harvested from this area are skin, fat, fascia, muscle and bone, alone or in combination as composite or chimeric flaps. This system is by far the most versatile and universal of all donor areas, which in turn can be adapted for multiple indications in all age groups with minimal donor site morbidity.