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The anterolateral thigh (ALT) flap is a workhorse soft tissue flap. Anteromedial thigh (AMT) flap has been used as a savior flap when lateral thigh perforators are absent. ALT and AMT flaps are based on cutaneous perforators arising from the descending branch of the lateral circumflex femoral artery (LCFA), a branch of the profunda femoris artery (PFA). Here, we present a case report of a chimeric ALT and AMT flap where the perforators were directly arising from the superficial femoral artery (SFA). This case highlights an unusual origin of the vascular pedicle in the ALT and AMT flaps and promotes the freestyle perforator flap harvest theory. Level of evidence: Level V, therapeutic study.

Song et al. reported an anterolateral thigh (ALT) flap as a septocutaneous flap in 1984. Conventionally anterolateral thigh flap is based on the perforators arising from the descending branch of the lateral circumflex femoral artery (LCFA), accompanied by two venae comitantes, one on either side. We present an infrequent anatomical presentation of descending branch of LCFA in which two arteries accompanied a single central vein. This pattern was exactly the opposite of conventional anatomy. One of the arteries (lateral) was arising from the LCFA main trunk, and the other (medial) artery was emerging from the LCFA branch to the rectus femoris muscle. The larger artery was used for arterial anastomosis, and the lone vein was used for venous anastomosis. The patient had an uneventful recovery. To the best of our knowledge, the unusual pattern described above is not reported before. Level of Evidence: Level V, risk / prognostic study