Revisiting The Blood Supply Of The Rectus Femoris A Case Report And Computed Tomography Angiography Study

Background Rectus femoris necrosis is a rare but severe complication after anterolateral thigh flap (ALTF) harvesting. It has been previously reported that the blood supply of the rectus femoris (RF) often arises from the same source artery as the ALTF; however, precise descriptions of the relationship remain limited. This article revisits the blood supply of the RF based on computed tomography angiography (CTA) and analyzes the possible influence of the blood supply on the RF during ALTF harvesting. Methods Between December 2017 and June 2018, CTA images of the bilateral lower extremities of 25 patients were studied. The RF length, number, and diameter of branches at the entry point into muscle, location, and overall branch vessel origins were recorded. Results The average +/- SD RF length was 384.73 +/- 19.28 mm. There were 170 branches (mean +/- SD, 3.4 +/- 0.96 branches per thigh), mainly arising from the lateral circumflex femoral artery. The average +/- SD diameter was 1.90 +/- 0.51 mm. The first branch was located at 1/5 of the proximal site of the RF, and 91% of all branches were located above the midpoint. The RF vascularity can be classified into 2 types: type 1 (36% of sides) has branches that arise from a single artery (descending lateral circumflex femoral artery or femoral artery), whereas type 2 (64% of sides) has branches at the 1/5 proximal and 4/5 distal parts, which arise from different arteries. Conclusions Preoperative CTA can provide anatomic information about the RF's nutrient vessel(s) and helps to optimize ALTF design.