The Anteromedial Thigh Free Flap Anatomy: A Clinical, Anatomical, and Cadaveric Study

Background: Perforator flaps have become the choice of most reconstructive surgeons because they have decreased donor-site morbidity. Among these flaps, the free anteromedial thigh flap has not yet become a first-choice flap because of the inconstant anatomy of its pedicle. This study aimed to describe the anatomy from different perspectives to highlight common patterns and simplify the flap's application in clinical cases. Methods: The study started in 2004 and took 9 years to complete. It was performed on 12 clinical anteromedial thigh flap cases, 48 clinical cases of anterolateral thigh flap in which the vascular anatomy of the anteromedial thigh flap was studied, and 48 cadaver dissections. Results: In type of perforators, the authors found an almost total consistency between clinical cases (group 1) and dissections in patients (group 2) ((2) = 0.164 and p = 0.92), whereas the cadaver dissections (group 3) were minimally homogeneous ((2) = 13.7 and p = 0.0082). Then, taking into account the parameter origin of perforators, they noticed the same trend with a clear alignment between the first two groups ((2) = 1.84 and p = 0.87) and a strong inhomogeneity in relation to the third group ((2) = 19.8 and p = 0.03). Conclusions: Anatomical study of the anteromedial thigh flap pedicle showed a marked variability that makes preoperative planning difficult, and thus more stressful to realize. This evidence confirms that the flap can be used as a second choice or simultaneously with the anterolateral thigh flap. In addition, the authors strongly suggest a preoperative radiological study to minimize the possible anatomical variabilities during surgery.