Background: The anterolateral thigh (ALT) flap is a
versatile perforator flap. It can be used as a pedicled flap, a
reverse flow flap, or a free flap. However, a thorough understanding
of the anatomic variations of the vascular pedicle of this
flap is important for successful flap elevation.
Aim: Presenting a case of unusual venous drainage of
reverse-flow anterolateral thigh flap.
Methods: We report a case of reverse-flow (ALT) flap < br />with anatomic variation of its venous outflow. During flap < br />elevation, an anomalous vein was found in the intermuscular
septum between the vastus lateralis and vastus intermedialis
muscles. Temporary occlusion of this vein resulted in intraoperative
flap congestion. So, we decided to include this vein
with the flap. The flap had two venous systems. The first
venous system was the vena comitantes of the descending
branch of the lateral circumflex femoral vessels and the second
was the anomalous vein that emerged from the vastus intermedius
muscle.
Results: Postoperative course was uneventful and the flap < br />survived completely. We did not observe any flap congestion
or flap arterial insufficiency. Complete wound healing was
achieved in 3 weeks.
Conclusions: We conclude that this anomalous vein has
a significant contribution to the venous outflow of this flap.
Meticulous planning and intraoperative dissection is needed
for successful elevation of ALT flap.