Applied anatomy and clinical application of the fascial pedicled flap with crural perforating branches

Abstract

Objective To characterize the distribution of crural perforating branches and to explore clinical application of the fascial pedicled flap with crural perforating branches.Methods The full source and distribution of all crural perforating branches were studied in 12 specimens of the lower limb while the perforating site,course,distribution and anastomosis of those with outer diameter ≥ 0.5 mm were measured in other 26 specimens.From May 1998 through November 2010,we treated 62 patients with soft tissue defects at the lower limb with close transposition of fascial pedicled flap with crural perforating branches.They were 50 men and 12 women,with an average age of 40 years (from 7 to 78 years).The vascularized fascial flaps were designed according to the courses of the crural perforating branches after Doppler monitoring.The defects were located at the upper tibia in 10 cases,at the middle and lower tibia in 32 cases,and at the ankle in 20 cases.The defect areas ranged from 2 cm × 3 cm to 9 cm× 16 cm.Results The autopsy located 4 obvious neurovascular chains in the medial,posterior,posterolateral and anterolateral regions of the leg and found the perforating branches were the most significant in regions of the medial saphenous nerve and posterior sural nerve.All the 62 patients in this series were followed up for an average period of 8 months (from 3 to 48 months).Two cases suffered scarring due to epidermal necrosis at the distal end of the retrograde flap,and one case had to receive secondary dermatoplasty due to partial skin necrosis at the distal end.The flaps survived well in the other 59 cases with satisfactory appearance and texture.Conclusions A facial pedicled flap can be conveniently harvested closest to the wound along the longitudinal course axis of the crural perforating branches in the 4 regions with rich neurovascular chains.This method is safe and simple to harvest a facial pedicled flap,with reliable blood supply and little disturbance to the perforating branches,which can be used to repair soft tissue defects at the leg effectively. Key words: Surgical flaps; Tissue transplantation; Wounds and injuries; Microsurgery; Anatomy