A reliable parameter for primary closure of the donor site of the descending branch of the circumflex femoral lateral artery perforator flap and analysis its effective factors

Abstract

Objective To explore a reliable parameter for primary closure of the donor site of the descending branch of the circumflex femoral lateral artery perforator flap and analysis its effective factors. Methods Between August, 2014 and December, 2015, 149 patients undergoing reconstructive procedures using the descending branch of the circumflex femoral lateral artery perforator flaps were included in the study. All patients were divided into two groups: primary closure of the donor site (135 cases) and none primary closure of the donor site (14 cases) . The receiver operating characteristic curve for biostatistical analysis was performed to identify the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap. The parameter, including the age, patients’ body mass index, subcutaneous fat thickness, thigh circumference and the maximum flap width, were recorded in 79 patients who were randomly choose from all patients. The method through stretching donor site skin was used to assess the maximum flap width. The maximum flap width-to-thigh circumference ratio was calculated. The Pearson test was used to analysis the correction between those parameters. Results Primary closure of the donor site was possible in 135 patients and impossible in 14 patients. The receiver operating characteristic curve for biostatistical analysis identifying the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap was 8.75㎝. The method assessed the reliable width of the flap was (8.37±1.67) cm through stretching donor site skin. the reliable width of the flap was (8.55±1.65) cm in the male patients and (7.42±1.5) cm in the female patients. Primary closure can be achieved if the flap width-to-thigh circumference ratio was less than (17.23±3.84) percent. There was a significant negative correlation between subcutaneous fat thickness and the ratio (R=-0.299, P < 0.05) and between body mass index and the ratio (R=-0.21, P < 0.05) . Conclusion The width of flap less than 8.75㎝ is a reliable parameter for primary closure of the descending branch of the circumflex femoral lateral artery perforator flap donor site. The patient’s body mass index and subcutaneous fat thickness of the thigh should be taken into consideration. Key words: Perforator flap; Circumflex femoral lateral artery; Donor site morbidities