The Anteromedial Thigh Flap

The anteromedial thigh (AMT) flap is not our first flap of choice, mainly due to its highly variant vascular anatomy and the less favorable donor site defect compared to the ALT flap. However, it is a good option in the plastic surgeon’s armamentarium when dissecting an ALT flap and no suitable perforators are found during surgical exploration. As a matter of fact, when harvesting an ALT flap, we always perform the anteromedial incision first and we do not proceed with the lateral incision until we have verified that there are adequate perforators that can carry the ALT flap with good inflow and outflow. If no suitable perforators are found, we typically explore the medial thigh in the subfascial plane to assess whether an AMT flap can be harvested. If a good perforator of the innominate (or medial branch/rectus femoris branch) of the descending branch of the lateral femoral circumflex is found, then an AMT is an option. If the decision is made to proceed with harvesting an AMT, then the previously performed medial incision of the ALT serves as the lateral aspect of the AMT. The AMT, similarly to the ALT flap is a Cormack type B flap. As discussed above, the most common blood supply to the flap is the innominate branch which courses posteromedial to the rectus femoris muscle. If that branch is small and not suitable to carry a flap, then the flap can be shifted to a more inferomedial aspect of the thigh. The blood supply to this newly designed flap are the septocutaneous branches surrounding the sartorius muscle arising from the femoral artery and vein.