A cautionary point in the harvest of the anterolateral thigh myocutaneous flap.

The anterolateral thigh myocutaneous flap is a versatile flap used for a variety of defects. The flap is usually harvested based on the descending branch of the lateral circumflex femoral artery. However, although the muscle is always reliable, sometimes the skin component is nonviable. The reason for this is that in a minority of patients, the skin in the lateral thigh is supplied by the perforators that originate directly from a source other than the descending branch of the lateral circumflex femoral artery, on which the flap is based. This case report illustrates this anatomic anomaly. We propose slight technical modifications when harvesting the anterolateral thigh myocutaneous flap to safeguard against such variations in the blood supply to the lateral thigh skin. With this modification in the technique of flap harvest, we have consistently been able to safely and reliably perform this flap.