Descending Branch of LCFA

ramus descendens arteriae circumflexae femoris lateralis

The descending branch of the lateral circumflex femoral artery (LCFA) arises from the LCFA main trunk and descends in the groove between the rectus femoris and vastus lateralis, giving multiple perforators through the vastus lateralis fascia to the anterolateral thigh skin. It is the dominant pedicle of the anterolateral thigh (ALT) free flap, the most versatile and commonly harvested free flap in reconstructive surgery.

Region: Thigh

Clinical Relevance

Clinical Notes

The ALT flap based on the descending branch of the LCFA is the workhorse free flap for head and neck, extremity, and trunk reconstruction. The flap provides thin or thick skin and subcutaneous tissue, with or without vastus lateralis muscle. Pre-operative colour Doppler or CTA maps the perforator locations along the axis from the ASIS to the superolateral patella. The flap can be thinned for intraoral tongue and palate reconstruction or bulked with muscle for dead space obliteration after radical resection.

Pathology

Common Injuries & Conditions

ALT Flap Perforator Mapping for Reconstruction

Pre-operative handheld Doppler or CTA identifies perforators of the descending LCFA branch along the line from ASIS to superolateral patella, localising the dominant perforator(s) to design the ALT skin paddle centred on the strongest vessel; most patients have two or more perforators suitable for harvest.