- The anterolateral thigh flap involves the skin paddle, the descending branch pedicle of the lateral circumflex femoral artery, and the perforators to the skin paddle.
- The descending branch pedicle is situated between the rectus femoris and vastus lateralis muscle.
- The major perforators to the skin paddle are normally located within a 2 to 3 cm radius from the midpoint between the anterior superior iliac spine and lateral border of the patella.
- In this unique case, both myocutaneous and septocutaneous perforators are present. More commonly, only a myocutaneous perforator is found, which traverses the medial edge of the vastus lateralis muscle.
- The vastus lateralis muscle is dissected to free the myocutaneous perforator. A small muscle cuff is left beneath the perforator to identify the orientation and prevent twisting and injury to the perforator.
- The pedicle is divided distal to the perforators. On the proximal end, the pedicle is divided distal to the branch to the rectus femoris muscle, preserving the blood supply to this muscle.
- The subfascial harvesting technique dissecting the plane below the fascia lata, taking the fascia with the flap. The fascia is carefully transected to maintain a safe distance of 2 to 3 cm to the perforators.
- Care is taken to spare the motor branch of the femoral nerve to the vastus lateralis muscle during dissection.