The vastus lateralis receives its blood supply from perforating branches of the lateral circumflex femoral artery (descending branch) and from direct muscular branches of the profunda femoris. These perforators enter the muscle on its deep surface at regular intervals.
The vastus lateralis perforators are the vascular basis for the anterolateral thigh (ALT) free flap, one of the most versatile reconstructive flaps. The perforators are mapped by Doppler preoperatively and confirmed during dissection. The flap is harvested around the dominant perforator in the junction of the proximal and middle thirds of the lateral thigh. Its fascial component provides sensate soft tissue for extensive wound reconstruction.
Failure to identify a dominant vastus lateralis perforator preoperatively by Doppler leading to intraoperative change in flap design or conversion to a muscular rather than perforator flap during anterolateral thigh free flap harvest.
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