Clinical application of the anterolateral thigh flap pedicled on the transverse branch of the lateral femoral circumflex artery for reconstruction of composite defects of the elbow

Abstract

Objective To reconstruct soft tissue defect of the elbow combined with brachial artery injury using anterolateral thigh flap that used the transverse branch of the lateral femoral circumflex artery as the vessel pedicle, and evaluate the clinical results. Methods Eight cases of brachial artery injury along with soft tissue defect at the elbow were treated between March 2000 and February 2008. Primary repair of the tissue defect was done by free transfer of the anterolateral thigh flap using the transverse branch of the lateral femoral circumflex artery as the vessel pedicle. The transverse branch of the lateral femoral circumflex artery was simultaneously inserted between the two ends of the injured brachial artery (3 to 7 cm defect). The areas of the skin defect ranged from 12 cm×6 cm to 20 cm×10 cm. Results Limbs and flaps of the 8 cases all survived. Postoperative follow up ranged from 10 months to 21 months. There were no obvious bulkiness and scar contracture of the tlaps. The average ROM of the elbows was 105°(95° to 125°). In all 8 cases, the pulse strength of the distal ulnar and radial arteries was the same as that of the uninjured side. Ultrasound detection of the brachial artery revealed blood flow of the injured side similar to that of at the uninjured fide. Conclusion When there exists vascular variation of the descending branch of the lateral femoral circumflex artery during dissection of the anterolateral thigh flap, the transverse branch of the hteral femoral circumflex artery can be used as the vessel pedicle of the flap. Made as a flow-through flap, this flap can be transferred to recommit soft tissue defects of the elbow combined with brachial artery defect. Key words: Wounds and injuries; Brachial artery; Surgical flans; Microsurgery