Fig. 1.

Schematic diagram illustrating the TPEX technique in an anterolateral thigh flap. A, Native anatomic configuration for which TPEX may be indicated. A dominant proximal perforator is found arising from the ascending branch of the lateral femoral circumflex artery (typically a TFL perforator). B, Perforator exchange involving rerouting of the ascending branch perforator and its vena comitans (via intraflap anastomosis) to a distal branch of the flap pedicle (the descending branch of the lateral femoral circumflex vessels).