Distal run-off vessel of descending branch of lateral femoral circumflex artery used for reconstruction of extremity defects with free anterolateral thigh flap

Abstract

Objective To explore the value of the distal run-off vessel of the descending branch of the lateral circumflex femoral artery in reconstruction of extremity defects with free anterolateral thigh flap. Methods From March 2009 to June 2013, 14 patients with extremity defects were repaired with free an-terolateral thigh flap that carried the distal run-off vessel of the descending branch of the lateral circumflex femoral artery. They were 13 men and one woman, with an average age of 34.6 years (from 8 to 57 years). The soft tissue defects involved the ankle and foot in 8 cases, leg in 3 and hand in 3, ranging from 5.5 cm×4.5 cm to 25.0 cm×14.0 cm in area. The distal run-off vessel was used in a flow-through flap for vascular reconstruction and wound coverage in 4 cases, in a flow-through flap for preservation of vascular continuity at the recipient site in 6 cases, in a recombinant chimeric flap for toe-to-2nd finger transplantation and simul-taneous flap resurfacing in one case, in a flap with connected transverse and perforating branches for repair of massive defects at the dorsal foot in one, and as a backup vessel to salvage a dying flap in postoperative ex-ploration of vascular crisis in 2 cases. Results The dissection time of distal run-off vessel was between 3 and 7 minutes (average, 4.6 minutes). The lengths of distal run-off vessels averaged 3.8 cm (from 1.5 to 6.0 cm). None complication occurred at the donor site due to removal of distal run-off vessel. The 14 patients obtained an average follow-up of 6.4 months (from 2 to 18 months). All the 14 flaps survived thoroughly. Follow-ups revealed no infection or necrosis but fine texture and colour. The foot recovered locomotion with good blood supply to the distal foot in 8 cases of ankle and foot defects and in 3 cases of leg defects. Three cases of hand defects gained fine functional recovery. Conclusions In surgery with free anterolateral thigh flap, the distal run-off vessel of the descending branch of the lateral circumflex femoral artery can play an important role because its easy dissection causes no additional injury to the donor site, an appropriate length can be harvested according to dif-ferent operational needs, and it can be used in a flow-through or a recombinant chimeric flap or as a backup vessel. Key words: Surgical flaps; Arteries; Microsurgery; Soft tissue injuries; Extremities