Penile reconstruction has always been one of the difficult problems of plastic surgery body surface organ reconstruction, according to the classic method of tube-roll tube forearm flap, abdominal wall flap penile reconstruction are classic reconstruction methods. The anterolateral femoral flap has been gradually applied to penile reconstruction in recent years due to its constant blood supply and vascular alignment. This article focuses on reviewing the blood supply of the anterolateral femoral flap and two cases of successful penile reconstruction. 1, clinical data Example 1 patient, male, 22 years old, in June 1995 was accidentally burned by high-voltage electrical burns in many parts of the body, after the injury in the local hospital, the left upper limb shoulder joint high amputation, penectomy, the left middle and lower abdominal position with a tibial flap transfer repair of the right lower abdomen, inguinal wounds, 2 months after the wound is healed. She was admitted to our hospital in March 2011 because of her request for penile reconstruction; on examination, she found that the left upper limb was missing, the left umbilicus, the anterior rectus abdominis muscle to the lower pubic symphysis, a “U”-shaped incision scar in the right inguinal area, and a piece of scar tissue on the anterior side of the right thigh in the upper third section, and her left lower limb was normal; her penile was missing in front of the pubic symphysis, and the scrotums were intact, with normal development; her development was normal. Both scrotums were intact, and the testes were in the scrotum with normal development; therefore, it was decided to apply the left lateral femoral vascularized tip anterolateral femoral island flap to reconstruct the penis. Example 2 The patient, female, 26 years old, with easy sex disease (F to M), underwent bilateral mastectomy + nipple reconstruction, hystereo-ovariovaginal resection + anterior urethral migration in our department in August 2009, and the urethra was extended through the mucous membrane of the anterior wall of the vagina of the patient during the urethral migration, and the patient underwent reconstructed penis with the right-rotation lateral femoral vascularized lateral femoral anterior-lateral insular flap in January 2010, because the patient couldn’t accept the post-operative scars in the abdomen and the upper limbs. 2 .Surgical method 2.1.Applied anatomy: the vascular tibia of the anterolateral femoral flap is the descending branch of the rotary lateral artery, according to the study of Luo Lisheng, Xu Dachuan, etc., the anterolateral femoral flap is a muscular septal vascular flap, and the descending branch of the rotary lateral artery is present in all of the dermatomes and the vascularization is constant; the line from the mid-point of the inguinal ligament to the mid-point of the line connecting the anterior superior iliac spine with the outer superior margin of the iliac bone ( iliopatellar line) is made as a connecting line, and the lower 2/3 of the section of this connecting line is The lower 2/3 of this line is the surface projection of the descending branch of the lateral rotator cuff; the descending branch of the lateral rotator cuff artery mainly originates from the lateral rotator cuff artery, and it can also be emitted from the deep femoral artery or the femoral artery, the lateral femoral nerve is accompanied by it, and it runs obliquely outward through the rectus femoris muscle and the middle femoral muscle, and it emits one to four branches near the midpoint of the line between the anterior superior iliac spine and the upper outer edge of the patella; the majority of the descending branch is a mylohyoid artery that passes through the lateral femoral muscle, and it is more slender as the branch is further down; the descending branch of the lateral rotator cuff artery The average outer diameter of the beginning of the descending branch of the lateral femoral artery is 3mm, and the average length of the two accompanying veins is 4.5mm, and the length of the descending branch as the vascular tip of the flap is 8~12cm. 2.2 Surgical procedure: Take example 1 as an example, the Doppler angiography detected that the point of penetration of the descending branch of the left lateral femoral artery was located in the line connecting the anterior superior iliac spine to the midpoint of the upper edge of the patella, and it was respectively 9cm away from the midpoint of the patella’s outer edge (the first penetrating branch point), 15 cm (the second branching point), and was marked in methylene blue. Taking the line from the anterior superior iliac spine to the upper outer edge of the patella as the central axis of the flap, the flap was designed in the lower part of the anterior lateral thigh, with a length of 10 cm and a width of 13 m. The proximal side of the flap was the midpoint of the line from the anterior superior iliac spine to the upper outer edge of the patella, i.e., the distance from the proximal side of the flap to the starting point of the rotator femoris lateralis artery was greater than that from that starting point to the root of the reconstructed penis; in order to take a flap with a wide fascial flap, it was necessary to isolate a perforation branch under the broad fascia, and then mark it at the midpoint of the inguinal ligament to the proximal margin and to the skin. To the proximal edge of the flap and the medial edge of the flap, cut the skin, subcutaneous, up to the broad fascia, in the rectus femoris muscle, lateral femoral muscle muscle gap, looking for the rotator femoris lateral artery and its descending branch, found that the descending branch were in the anterior superior iliac spine to the upper edge of the outer edge of the patella line at the midpoint of the distal side of the point 4cm, 10cm, issued by the two muscle branch into the lateral femoral muscle, and to the myocutaneous perforating branch out of the muscle into the broad fascia and the flap, the diameter of the 0.5mm, 1mm, with veins and femoral and femoral flaps, respectively. The other three sides of the flap were incised to the deep surface of the broad fascia, and the other muscle branches and the distal descending branch were separated, severed, and ligated to form the vascular tip of the flap, and the nerve was severed at the point of entry into the muscle, and part of the muscular sleeve of the lateral femoral muscle was retained around the perforating branch; the island flap was passed under the rectus femoris muscle and the suture muscles, and the skin was incised and cut, subcutaneously, and formed a tunnel to transfer to the pubic symphysis; the island flap was incised and cut into the rectus femoris muscle, the suture muscles, and the muscle was cut to form a tunnel. Pubic symphysis; cut 9cm×3cm scrotal mediastinum skin flap, suture roll to form the urethra; island skin flap wrapped reconstructed urethra, reconstructed penis is completed; donor flap area planted medium-thick skin piece closed. 3, Discussion 3.1, penile reconstruction has a variety of methods, each with its own advantages and disadvantages, the use of anterolateral femoral island flap reconstruction of the penis is rare, Chen Shouzheng has reported the use of this method of reconstruction of the penis in 7 cases, this method of the lower abdominal wall flap subcutaneous tissue is thin, the flap with the thigh broad fascia, to enhance the toughness of the reconstructed penis, so that the body of the penis is more voluminous, reducing the degree of atrophy in the postoperative period, late implantation of costal cartilage or rib cage support, not easy to expose, long-term treatment, and the penis is not easy to be exposed, but it is not a good choice for the treatment. In the later stage, rib cartilage or rib support can be implanted, which is not easy to be exposed, and the long-term effect is more satisfactory. For the body fat abdominal wall subcutaneous fat more people, especially easy sexually transmitted diseases (female to male) patients, fat is female distribution, abdominal fat is thicker, can also be used as one of the first choice of surgery. 3.2, Example 1 patient due to extensive trauma to the lower abdomen, parumbilical and subcutaneous abdominal wall vascular injuries possible, blood supply is not exact, abdominal flap method is not feasible. Due to the absence of the left upper limb, the patient needs to rely on the right upper limb for self-care, so it is not appropriate to choose the forearm flap method. Other parts of the flap are more distant, need to perform microsurgical anastomosis of blood vessels, the surgical operation is more difficult. In this patient, the anterolateral femoral island flap is more feasible for penile reconstruction. 3.3 The anatomy of the descending branch of the lateral femoral blood vessels is constant, the flap is taken from the thigh, the donor area is more hidden, and the patient is happy to accept it, the cutting of the flap does not destroy the important blood vessels and nerves of the limb, and it does not affect the function of the lower limb after surgery; one of the keys to the success of the operation is to dissect the area very carefully and avoid damaging the musculoskeletal perforating branches that supply the blood supply of the flap. 3.4 Although the subcutaneous fat of the anterolateral femoral island flap is thicker than that of the forearm flap, the urethra and penis reconstruction can also be accomplished in men by the flap method in a single stage, but the reconstruction method of the tube rolled up will inevitably increase the incidence of postoperative urethra-related complications, and the reconstructed penis is relatively thick is the shortcoming of the beauty of it. In this case, the scrotum of the male patient was in good condition, and the mediastinal scrotal flap was thin and had sufficient blood supply, so this flap was used to reconstruct the urethra, which effectively avoided the situation that the reconstructed penis was too large. In female-to-male patients with sexually transmitted diseases, the urethra can be reconstructed through the vaginal mucosa, and the urethra can also be reconstructed in one stage by wrapping the femoral anterolateral flap outside the urethra. These two methods can effectively avoid the occurrence of large reconstructed penis, and this procedure can effectively reduce the occurrence of postoperative urethra-related complications, taking into account the function and appearance, which is worth promoting.