[A double-island flap based on the lateral circumflex femoral artery for soft tissue reconstruction after radical resection of advanced oral and oropharyngeal cancer].

Objective

To report the surgical strategy for harvesting a double-island flap based on the lateral circumflex femoral artery (LCFA) for reconstruction of complex soft tissue defects following radical resection of advanced oral and oropharyngeal cancer.

Methods

A retrospective analysis was conducted on 93 patients (87 males, 6 females; age range, 32-72 years) with T4-stage oral and oropharyngeal carcinoma who underwent combined jaw-neck radical resection and reconstruction with a single-pedicle double-island anterolateral thigh free flap at the Second Xiangya Hospital of Central South University between July 2020 and September 2025. All flaps were harvested via a medial approach. Perforators in the anterolateral or anteromedial thigh region were identified, and the origin of anteromedial perforators from the LCFA was confirmed following dissection of the rectus femoris muscle. Perforators were then traced retrogradely to the main trunk, and the descending and transverse branches of the LCFA were exposed within the intermuscular space between the rectus femoris and vastus lateralis muscles.

Results

The double-island flap was successfully harvested in all 93 patients. Flap combinations included descending+descending branch (n=51), descending+transverse branch (n=26), descending+anteromedial perforator (n=15), and transverse+anteromedial perforator (n=1). In 31.2% (29/93) of cases, anteromedial perforators originated from the LCFA. The mean flap area was (168.20±21.35) cm². The overall mean perforator diameter was (2.49±0.43) mm, with anteromedial, transverse, and descending branches measuring (2.89±0.44) mm, (2.60±0.49) mm, and (2.43±0.39) mm, respectively. The shorter pedicle length was (10.81±1.77) cm, and the longer was (20.53±2.57) cm. In 92 cases, a single arterial and venous anastomosis sufficed. In one case without communicating veins between the two branches, one artery and two veins (the dominant vein from each branch) were anastomosed.

Conclusion

The LCFA-based double-island flap provides robust and reliable vascularity, representing an effective reconstructive option for complex soft tissue defects following radical resection of advanced oral cancer.