Using the descending branch of the lateral femoral circumflex vessel as a source of two independent flaps

Background: Simultaneous reconstruction of two separate defects by two free flaps is time consuming and often requires two donor sites. The anterior and lateral aspect of the thigh is an ideal donor site for free tissue harvest without incurring significant morbidity. In this article, the authors describe their recently developed technique that allows for harvesting two independent fascio-cutaneous free flaps from the same descending branch of lateral circumflex femoral vessel as a new clinical application of the versatile anterolateral thigh flap. Methods: A total of eight flaps were developed from left thighs of four patients. There were two male and two female patients, with a mean age of 42.0 years. The defects were either on the lower extremity (n = 2) or in the oral cavity (n = 2). Each anterolateral aspect of the thigh was used to develop two perforator flaps, based on one perforator each. The anterolateral thigh flap was elevated in the standard manner based on at least two cutaneous vessels of the descending branch of the lateral circumflex femoral artery. The skin flaps were tailored to the recipient site requirement and the main descending branches of the lateral femoral circumflex vessels were divided in between to be used as the pedicle of both flaps. The mean flap dimensions ranged from 2.5 x 4 cm to 8 x 12 cm (mean, 5 x 8 cm). The mean operation time was 11 hours 30 minutes. The mean length of the pedicle was 9 cm (ranged, 8 to 11 cm). The mean external diameter of the descending branch in the mid thigh and where it joined to the lateral circumflex femoral artery was 1.75 mm and 3 mm, respectively. Three donor sites were closed directly and one was grafted. Results: All flaps survived completely. No complications were encountered. Donor-site morbidity was negligible. Hospitalization averaged 9.9 +/- 1.7 days. Conclusion: Two fasciocutaneous flaps based on independent skin vessels can be reliably harvested from the same descending branch of the lateral femoral circumflex artery for simultaneous reconstruction of two separate defects.