CT angiograph in lateral circumflex femoral artery perforators visualization

Objective To provide clinical guidance for clinical selection, through retrospective analysis for the advantages and disadvantages of superficial iliac circumflex artery and lateral circumflex femoral artery perforator flap in wound repair. Methods From July 2016 to January 2018, 89 cases were repaired with superficial iliac circumflex artery or lateral femoral circumflex artery perforator flap, including 32 cases of superficial circumflex iliac artery perforator flap, 18 cases of upper limb, 6 cases of face and neck, and 8 cases of lower extremity. There were 52 cases of lateral circumflex femoral artery perforator flap, 21 cases of upper limb, 2 cases of neck, 3 cases of trunk, 26 cases of lower extremity, 5 cases of superficial circumflex iliac artery perforator flap combined with lateral femoral circumflex artery perforator flap, 3 cases of upper limb and 2 cases of lower extremity. The perforators of superficial circumflex iliac artery or (and) lateral circumflex femoral artery were detected by portable Doppler flow detector before operation. According to the wound size, the superficial circumflex artery perforator flap or (and) lateral circumflex femoral artery perforator flap was or (were) designed and resected. End-to-end or end-to-side anastomosis was performed in vascular pedicle. In the combined resection group, the end-to-end or end-to-side anastomosis of the perforator of the lateral circumflex thigh artery was performed, and the pedicled part of the superficial circumflex iliac artery was used for supercharging. Results All the flaps survived successfully except one combined flap had tip necrosis on the superficial iliac circumflex artery perforator flap part. and healed after 2 weeks of dressing change. Venous crisis occurred on the first day after operation of superficial iliac circumflex artery perforator flap in 1 case.10 cases of lateral femoral circumflex artery perforator flap were slightly bloated and 3 cases returned to hospital for secondary thinning. All the flaps were soft in texture, satisfactory in shape and function, and numbed in the small area of the donor region of the perforator flap of lateral femoral circumflex artery in the early stage. All the patients had no severe complications after follow-up. Conclusions The perforator flap of superficial iliac circumflex artery and lateral femoral circumflex artery are ideal donor areas for wound repair. The perforator flap of superficial iliac circumflex artery is preferred for small area wound, hand wound and small bone defect. Lateral circumflex femoral perforator flap is suitable for all trunk and limbs with large or complex wounds. Key words: Surgical flap; Superficial iliac circumflex artery perforator flap; Lateral circumflex femoral artery perforator flap; Perforator flap

The common femoral artery (CFA) divides into the superficial femoral artery (SFA) and deep femoral artery (DFA). The lateral circumflex femoral artery (LCFA) and medial circumflex femoral artery (MCFA) are most often branches of the DFA, although a large number of different variations in their origin has been described. We performed microdissection on both lower limbs of 30 fetuses, gestational age from 7 to 10 lunar months. Our results show that the LCFA and MCFA usually arise from the DFA. In 78.3% of cases, the MCFA originated from the DFA. In 11.7% of cases, the MCFA originated from the CFA, and in 5% of cases from the SFA. One case showed a common trunk with the DFA. Also, the MCFA was missing in one case, and it had a common trunk with the LCFA in one case. In 83.3% of cases, the LCFA arose from the DFA and in 6.7% of cases from the CFA. In one case, it had a common trunk with the DFA, and in one case with the MCFA. In 3.3% of cases, the LCFA was missing. In 66.7% of cases, both arteries originated from the DFA, in 15% of cases one originated from the DFA and the other from the CFA or SFA. Our results are in accordance with some published studies but also differ from the outcomes of other studies. Comprehensive knowledge of different variation types is imperative in order to prevent complications during surgical and orthopedic interventions.

The lateral femoral circumflex artery (LFCA) and its descending branch (DB) are important collaterals of the profunda femoris artery. The success of a profundoplasty may be enhanced by improving LFCA flow, while inadvertant compromise of the LFCA lumen may adversely affect the results of a profundo plasty. The angiographic anatomy of the LFCA was studied in 200 limbs of patients undergoing aortography for leg ischemia. There were four major anatomic var iations of the LFCA and its DB in respect to their origin from the common and deep femoral arteries. Mean length of the LFCA was 2.5 cm and mean diameter 3.5 mm. Atherosclerotic changes, mainly at the orifice, were seen in 15% of LFCAs. The DB of the LFCA was an important collateral in 102 limbs, in 34 it was the main collateral in the thigh. Its diameter was 3 mm or more in 50% of limbs. These data show the anatomic basis for attempting adjunctive surgical procedures on the LFCA. Preliminary results are reported of 36 profundoplasties during which a spe cific surgical maneuver was directed at the LFCA. Intraoperative blood flow measurements were performed to quantify the LFCA flow capacity and to com pare flow through the LFCA to distal profunda flow. The LFCA and its DB are important collaterals and should be given specific attention in selected cases.

Objective- To study the variations in origin of profunda femoris artery and its branches in cadavers. Materials and Methods - In the present study, dissection was performed on 60 lower extremities of 30 embalmed cadavers in the department of anatomy, Dr.D.Y.Patil Medical college, Kolhapur. Prevalence of the mode and configurations of origins of the profunda femoris artery, medial and lateral femoral circumflex arteries were observed. Result- In our study we found that Profunda femoris artery was originating from the femoral artery 37.12 mm distal to the midpoint of the inguinal ligament. The lateral and medial femoral circumflex arteries were originating directly from femoral artery in 15% and 22% of extremities respectively. Conclusion- Clinicians and surgeons should be fully aware with such variations while performing any invasive, diagnostic and therapeutic procedures.

Purpose: To evaluate the utility of 64-multidetector computed tomographic (CT) angiography with 3D reformations for preoperative vascular anatomy evaluation, lateral femoral circumflex artery and course of perforator vessels assessment in anterolateral thigh flap planning. Material and Methods: Informed consent and institutional review board approval were obtained. Seven patients underwent 64-multidetector CT angiography to identify the lateral femoral circumflex artery perforators prior to oncologic and post-traumatic reconstruction surgery (3/7 patients analyzed bilaterally). Preoperative color Doppler US evaluation was performed. Surgical findings were correlated to imaging using a 0-3 scale Image Relevance Score (IRS) of the multidetector CT. Results: Perforator arteries suitable for surgery were identified in 7/7 patients. Surgical findings were consistent with CT findings for perforator caliber and course. CT identified several anatomical variants. In 1 patient preoperative imaging was performed with no difference in management (IRS=0); in 3 patients moderate intraoperative difficulties were found with increase of operative time (IRS=1); in 2 patients major intraoperative difficulties were encountered, with need for intraoperative change of surgical technique (IRS=2). In the remaining patient CT findings avoided surgical failure (IRS=3). Conclusion: 64-multidetector CT angiography accurately mapped vessels for preoperative evaluation of lateral femoral circumflex artery perforators in anterolateral thigh flap planning in 7 patients.

Introduction: The research of the lateral femoral circumflex artery has been studied and applied in many clinical fields. Objectives: To investigate branched anatomical features of the lateral femoral circumflex artery used in the construction of the composite anterolateral thigh (ALT) flap. Patients and research methods: 60 thigh areas of 30 Vietnamese adult cadavers meeting the research standards were conducted cross-sectional descriptive analysis. Result: lateral femoral circumflex artery usually has three branches that are ascending branch, oblique branch and descending branch. Descending branch usually separated independently (11.7%), oblique branch and ascending branch often have common body (83.3%). The majority of ascending branches have origin from lateral femoral circumflex (76.7%). Ascending branche has average of 4.1 branches to supply the anterior thigh muscles. Ascending branches has 2-3 cutaneous perforators were the majority (41.7%). There are 73 descending branch, 75.34% descending branch from the original branch of the lateral femoral circumflex artery, 8.22% lateral femoral circumflex artery from femoral artery and 16.44% descending branch from deep femoral artery. Averaging descending branch has 8.9 ± 0.2 branches to muscles of anteriolateral thigh area and on average had 3.1 ± 0.3 perforators per thigh specimen. The number of branches to lateralis muscles was at most 7.9 ± 0.4 branhes. Conclusion: Anatomical research of the lateral femoral circumflex artery branching as a premise to build a composite ALT flaps with lateralis component or with TFL makes sense in the creation of workhorse materials in clinical application. Key words: lateral femoral circumflex artery

Objective To evaluate the feasibility and clinical efficacy of lateral femoral circumflex artery perforator flaps and fit together in the treatment of limbs complex wound surface.Methods From January 2010 to March 2012,use the characteristics that the descending branch of lateral femoral circumflex artery extend its branches over the flap,fascia and skin,to form lenticulostriate arteries,which contain 2 to 3 different species tissues fits together,flaps cover the important tissues such as vessel,nerves and bones.Fascia covers the tendinous tissues etc.Muscle can not only cover the tissues,but also fill in the space,and followed by skin grafting.This research was to perform the treatment for 4 cases of lacking limbs ring tissue,three cases of multiple wound surface,six cases of hand avulsion injury of skin and 9 cases of Gustilo grade-Ⅲ C.Results As for the 22 cases in the research,nineteen cases of flaps survived,the other 3 cases were necrosis with length of 1cm to 2 cm at distal and self-healed later.During 6 months to 2 years followed-up of 18 cases,external flaps were satisfactory,skin grafting over the fascia layers develops very well,smooth with great elasticity,no recoil,and no color change.Conclusion Lateral femoral circumflex artery is one of effective restoration methods for limbs with complex wound surface. Key words: Lateral femoral circumflex artery; Perforator flaps; Chimeric perforator flap; Transplantation; Microsurgical operation

Confirming the branching pattern of the deep femoral artery (DFA) is vital in planning radiological and surgical procedures involving the medial circumflex femoral artery (MFCA) and the lateral circumflex artery (LFCA). The aim of this study was to characterise the course and morphology of branches of the DFA. The anatomical dissection included 80 lower limbs which were fixed in 10% formalin solution. A dissection of the femoral region was carried out according to a pre-established protocol, using traditional techniques. Morphometric measurements were obtained twice by two researchers. Six types of medial and lateral femoral circumflex artery variations were distinguished. In type I, the DFA divides into the MFCA and the LFCA (observed in 45% of cases). In type II, the MFCA is absent and the LFCA origin normally from the DFA (18.75%). In type III, the MFCA arises from the femoral artery above the origin of the DFA, while the LFCA starts from the DFA (15%). Finally, in type IV, the LFCA arises from the femoral artery above the origin of the DFA, while the MFCA starts from the DFA (10%). In type V, the LFCA origin alone from the femoral artery below the origin of the DFA, while the MFCA origin from the DFA (7.5%), while in type VI (3.75%), both the MFCA and the LFCA origin from the femoral artery. The mean diameter of the femoral artery at the level of the DFA origin was greatest in type 2 (10.62 ± 2.07 mm) and the least in type 6 (7.90 ± 1.72 mm; p = 0.0317). The distance from inguinal ligament to where the DFA arose was the greatest in type 6 (78.24 ± 29.74 mm) and least in type 5 (28.85 ± 11.72 mm; p = 0.0529). The medial and lateral femoral circumflex arteries were characterised by high morphological variations. The diameter of the femoral artery at the level of inguinal ligament correlated with the diameter of the DFA and distance to where the DFA arises from femoral artery.

Normal variations of the subcutaneous and deep branches of the proximal part of the femoral artery are commonly observed on cadavers. Our study involves observations and descriptions of the deep branches of the proximal part of the femoral artery. These branches typically occur inferior to the subcutaneous arteries and include the deep femoral artery and the medial and lateral circumflex femoral arteries. The circumflex femoral arteries may arise from the deep femoral artery as a common trunk or with separate, distinct origins. The circumflex femoral arteries have also been reported as independent branches that arise from the femoral artery. Herein we describe two variations of the circumflex femoral arteries that have not previously been observed. First, we observed an unusually long common trunk for the medial and lateral circumflex femoral arteries that arises from the femoral artery inferior to the subcutaneous branches, but superior to the branch of the deep femoral artery. In addition, the common trunk of the circumflex femoral arteries is similar in diameter to the deep femoral artery. The second variation observed is a common trunk for the medial circumflex femoral and inferior epigastric arteries that arise from the femoral artery superior to the deep femoral artery.

Few studies have assessed trochanteric vascularity despite its implications for bone healing and surgical approaches. This study aimed to assess the regional arterial contributions of the medial femoral circumflex artery (MFCA) versus the lateral femoral circumflex artery (LFCA) to trochanteric vascularity. Ten adult human cadaveric pelvises to mid-femur specimens were obtained. One hip was randomly assigned experimental (either MFCA or LFCA MRI-contrast infusion) and contralateral as control (MFCA and LFCA magnetic resonance imaging [MRI]-contrast infusion). Vascular dissection was performed for MFCA and LFCA cannulation. Pre- and post-contrast 3T MRI was completed, and intra-osseous contributions were quantified by region: greater trochanter (GT), intertrochanteric (IT), lesser trochanter (LT) and subtrochanteric (ST). A polyurethane compound mixed with barium sulfate was injected into the LFCA cannula, and into the MFCA cannula for the contralateral hip. Computed tomography (CT) imaging was completed to assess terminal branch locations. MFCA provided the majority of arterial contributions to the full trochanteric region (68.5% MFCA, 31.5% LFCA; standard deviation [SD]: 10.7%, p < 0.001). Over 70% of arterial contributions to ST, LT and IT regions are derived from MFCA. GT contributions were more balanced (52.5% MFCA, 47.5% LFCA; SD: 33.7%; p = 0.853). Significant differences were found between MFCA and LFCA contributions in all regions except for the GT. CT revealed multiple consistent MFCA and LFCA trochanteric terminal branches. MFCA provided the dominant trochanteric arterial supply, which highlights MFCA's importance to overall hip vascularity. LFCA's trochanteric contribution was smaller but still provided trochanteric contributions, especially the GT region. Knowledge of trochanteric arterial contributions can be beneficial for optimizing surgical approaches and fixation to protect terminal branches during trochanteric fracture, nonunion treatment and trochanteric osteotomies. Not applicable.

“Trifurcation” of femoral artery

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

IntroductionThe most significant blood vessel supplying the hip joint is the medial femoral circumflex artery (MFCA). MFCA with lateral femoral circumflex artery (LFCA) are the first branches of the deep femoral artery (DFA) or they originate directly from the common femoral artery (CFA) or superficial femoral artery (SFA).Purpose and methodsWe analyzed 100 CT angiogram of the hip region [72 men, 28 women; mean age 46.4 (14–80)] to assess the frequency of each type of division of the MFCA and LFCA from either the DFA or directly from the CFA or SFA. To assess the variations on each side in one individual we analyzed both hips in 73 patients [mean age 46.6 (14–80)].ResultsMany different types of division have been described. The most frequent one in which both the MFCA and LFCA originate from the DFA, was observed in 50% of patients. In 31% of hips the MFCA originates from the CFA. In our study, a normal origin of the obturator artery from the internal iliac artery was observed in 67% of patients and an atypical origin, called corona mortis was observed in 33% of patients.ConclusionsThe deep branch of the MFCA is the main artery supplying the femoral head, it is at risk during surgical approach to the hip joint. The atypical anastomosis called corona mortis is also at risk while performing the approach to pubic bone. Therefore, knowledge of their topography is very important.

The medial and lateral circumflex femoral arteries are critical to the proper perfusion and function of the hip joint. The lateral circumflex femoral artery (LCFA) is used a graft material in coronary artery bypass, and tissue flaps that include this artery, are harvested for plastic surgery reconstructions. Although the two circumflex femoral arteries typically originate from the deep (profunda) femoral artery (DFA), variations in their origins have been reported. Here we report on a unique variation of the LCFA in a donor body. A cadaveric dissection of the anterior thigh was bilaterally performed at the University of Incarnate Word School of Osteopathic Medicine to demonstrate the origin and branching of the LCFA. Bilateral asymmetry in the origin of the LCFA and the medial circumflex femoral artery (MCFA) was observed in this cadaver. On the left side, the LCFA originated from the common femoral artery (CFA) deep to the inguinal ligament. On the right side of the body, the LCFA originated from the DFA. While the MCFA took origin from the DFA on the left side of the body, it shared a common origin with the DFA from the CFA on the right side. In summary, we report a unique unilateral variation of the LCFA where it originates from the CFA deep to the inguinal ligament. This high origin for the LCFA, at the boundary between the external iliac and femoral arteries, has not been previously reported and is unique even among mammals. It is important to determine the branching patterns of the LCFA and the derivative branches of the femoral artery as they are critical arterial pathways for the lower limbs and because the LCFA is a target in coronary grafts and plastic surgery skin flaps.

Anatomical variations in the origins of the lateral circumflex femoral arteries in a South African sample: A cadaver study