There are several perforator flaps that use pedicles from branches of the lateral circumflex femoral artery. Among them, the anterolateral thigh flap is frequently used in head and neck reconstruction; however, it often has anatomical variations in the vessels. We report a case with anatomical variation of the lateral circumflex femoral artery during elevation of the anterolateral thigh flap. The patient was a 77-year-old man. He was scheduled for a subtotal maxillary resection and reconstruction for supragingival carcinoma. We found a perforator at the midpoint of the straight line connecting the anterior iliac crest and the lateral patella, and confirmed that it was an oblique branch of the lateral circumflex femoral artery. It is necessary to select an appropriate perforator so as not to impair blood flow when elevating the anterolateral thigh flap. Preoperative CT angiography and ultrasonography are recommended to ensure safe and reliable elevation.
