Anatomic features of the oblique branch of lateral circumflex femoral artery and its clinical significance

Abstract

Objective This study revisits the blood supply of the oblique branches in the light of recent advances in the understanding of the vascular anatomy of the anterolateral thigh, and observes its clinical application effect. Methods From January, 2014 to January, 2016, a prospective intraoperative observational study was performed in 57 consecutive anterolateral thigh flaps, noting the dimensions and locations of the oblique and descending branches and the number and size of the muscle branches supplying the rectus femoris. Twenty-one patients were found with the oblique and descending branches and performed the free flap pedicled with collateral branch of oblique rarus of lateral circumflex femoral artery to fix the foot and ankle in 12 cases. There were 8 males and 4 females with an age range from 23 to 52 years. They were injuried by traffic accident (6 cases), by object hit from height (4 cases),or hurted by machines (2 cases). The locations were foot in 5 cases, ankle in 4 cases, and at the distal shank in 3 cases. The disease duration was 4 hours to 36 hours (mean, 16 hours). Six skin flaps, 4 fascia flap plus skin flap, 2 ramified flaps harvest were then completed as planned. The size of flaps ranged from 7 cm × 11 cm to 8 cm × 21 cm, and the donor sites were closed directly in all cases. Results On the basis of the dimensions and locations of the oblique and descending branches supplying the rectus femoris, all cases were devided into type I (descending branche, 16 cases), type II(the oblique and descending branche, 2 cases), type III(oblique branche, 3 cases). After operation, all the flaps survived, while wound dehiscence accured in 1 case and healed after dressing change and left a slash residual scar without pulling discomfort. The donor site was accompanied by a decrease in the range of peripheral sensory numbness. Early muscle strength of hip and knee arised in 3 cases, got better in 3 months and dispeared in 6 months. By way of telephone follow-up, 12 patients were followed for 3-24 months (mean, 13 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking. Conclusion Blood vessels should be carefully identified, while flaps are harvested with diversity of blood supply. As it is improved that the oblique branch of lateral circumflex femoral artery perforator tissue flap is simple and reliable, also can perform various forms of perforator flaps. Key words: Oblique branch, lateral circumflex femoral artery; Perforator flap; Applied anatomy; Repair