Branch Of Circumflex Femoral Artery Research Articles

Chimeric perforator flap based on the descending branch of lateral circumflex femoral artery for tongue reconstruction after advanced tongue cancer resection

Objective: To explore the advantages and clinical efficacy of free chimeric perforator flap based on the descending branch of circumflex femoral artery applied to tongue reconstruction after advanced tongue cancer resection. Methods: From October 2013 to December 2018, 57 cases received tongue and oral base reconstruction surgeries using the descending branch of circumflex femoral artery chimeric perforator flap, including 39 males and 18 females, ranged from 20 to 76 years old. And all cases were with stage T3 and T4 tongue cancers, including 35 cases of squamous cell carcinoma, 7 cases of low differentiation cancer, 5 cases of oncosarcoma, and 10 cases of adenoid cystic carcinoma. The tongue was reconstructed by using perforator flap and muscle flap to fill the dead space at the oral floor. The artery anastomoses with the superior thyroid artery or facial artery in the receiving area, and the vein anastomoses with the internal jugular vein in the receiving area. The shape, function and local complications of the reconstructed tongue were observed after operation. Results: Of 57 cases, only one case had partial necrosis of flap, while other 56 cases with chimeric perforator flap survived. Postoperative gastric tube and tracheal cannula were removed in all patients, no cases with oral fistula. All donor sites were sutured in one stage. Postoperative radiotherapy was performed in 41 of the patients. All patients were followed up for 3 to 60 months (average of 20.7 months), with satisfactory esthetic and functional results in reconstructed tongues. Only linear scars were left in the donor areas of the legs, and no lower limb dysfunction was observed. Conclusions: The descending branch of circumflex femoral artery chimeric perforator flap can used for repairing simultaneously the defects of both tongue and oral base. It is helpful to avoid the occurrence of oral fistula and to provide the reconstructed tongue with a good function. It is a good choice to use the descending branch of circumflex femoral artery chimeric perforator flap for tongue reconstruction after resection of advanced tongue cancer resection.

One plus one: Two free flaps from same donor thigh for simultaneous coverage of two different defects.

Introduction:Primary microvascular reconstruction of multiple defects is challenging particularly if it has to be simultaneous. In trauma cases, harvesting two independent free flaps from different sites is very time-consuming and adds to morbidity. To eliminate these disadvantages, we sought to find out a reliable alternative method of harvesting two independent free flaps based on the descending branch of circumflex femoral artery, i.e., one anterolateral thigh (ALT) flap and one rectus femoris muscle flap.Aim:To study the feasibility of transferring two free flaps, i.e., ALT and rectus femoris muscle flap simultaneously from the same thigh for coverage of two different limb defects.Materials and Methods:From 2003 to 2012, five patients with two defects each were managed with a total of ten flaps harvested from five donor sites based on independent pedicles of descending branch of lateral circumflex femoral artery and used to cover severe injuries of extremities. Three cases had both lower limb defects and two cases had one upper limb and one lower limb defect. In each case, one ALT flap and one rectus femoris muscle flap were used for coverage.Results:All reconstructive procedures were completed without any major complications. All flaps survived well. There were no re-explorations and no complications related to donor sites.Conclusion:We conclude that our approach of simultaneous harvest of ALT and rectus femoris muscle from the same thigh offers two flaps for two different defects in terms of economy of donor site and operating time.

A novel step in the anterolateral thigh free flap harvest

The ALT is a versatile flap in head and neck reconstruction1. Classically this flap allows for suprafascial or subfascial identification of perforators. Subsequent retrograde dissection of the perforators through the intermuscular septum or muscle identifies the pedicle (descending branch of the lateral circumflex artery). This technique can be time consuming and risks injury to the delicate perforators. • Technique used in 75 consecutive patients undergoing ALT flap. • Approximate harvest time is 1 hour. • No change in infection or hematoma at donor site has been observed. • No neurovascular injury. • Complication: false loading GIA stapler (1) which required obtaining hemostasis with bipolar cautery. The Anterolateral thigh (ALT) flap, based on branches of the circumflex femoral artery, has increasingly become a popular flap in head and neck reconstruction because of its versatility1 י2. Classically described as a perforator flap, the ALT flap can be harvested to include skin only, skin and muscle and as a chimeric flap with separately perfused skin paddles2 י3. As with all free tissue transfer procedures in the head and neck, efficiency in technique is paramount in reducing the overall surgical duration. We describe the technique of retrograde pedicle dissection and the adapted use of a GIA 80 stapler in harvesting ALT flaps. This technical modification has been implemented in 75 consecutive patients with an approximate harvest time of one hour. 1.Song YG, Chen GZ, Song YL. The free thigh flap: A new flap concept based on the septocutaneous artery. Br J Plast Surg 37:149-159, 1984. 2. Demirkan F, Chen HC, Wei FC, et al. The versatile anterolateral thigh flap: A musculocutaneous flap in disguise I head and neck reconstruction. Br J Plast Surg53:30-36, 2000 3.Xu DC, Zhong SZ, Kong JM, et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg 82:305-310,1988. 4. Koshima I, yamamoto H, Hosoda M et al. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions:An introduction to the chimeric flap principle. Plast Reconstr Surg 92: 411-427, 1993. Technique Step 1: The ALT is exposed and a flap is designed based upon the perforators. Step 2: The medial edge of the flap is incised down to fascia. The septum between the rectus femoris vastus lateralis muscles is identified and separated. Step 3: The descending branch of the circumflex femoris artery is identified as it courses on or through the vastus lateralis muscle. Step 4: The perforators to the flap are then clearly identified and outlined. Step 5: The lateral margin of the skin flap is incised down to fascia. Step 6: While protecting the perforators and the main pedicle, the GIA staple is applied to divide a cuff of the vastus lateralis muscle above and below the most superior and inferior perforators. Step 7: The descending branch of the lateral circumflex femoral artery is then traced in a retrograde manner till adequate pedicle length and vessel caliber is achieved. Step 8: The flap may be thinned down, when desirable, by carefully debulking muscle and subcutaneous fat from the flap periphery. For very thin flaps, antegrade dissection of the perforators through the vastus lateralis muscle may be necessary. • Safe technical modification. • Efficiency in a time consuming procedure. • GIA stapler beneficial to the pedicle No thermal energy for hemostasis In single maneuver keeps protective cuff of muscle to protect pedicle. The flap is harvested in typical fashion with the exception of a novel technical modification . We outline the technique used at our institution for ALT flap harvest: Results

Vascular Supply of the Tensor Fasciae Latae Flap Revised

Sir: The lateral aspect of the thigh is an important donor site for flap harvest due to the high number of type B and C perforators suitable for pedicled and free tissue transfer. The tensor fasciae latae flap, originally described by Hill (in Plastic and Reconstructive Surgery in 1978), represents an important source of soft tissue for composite and functional reconstructions. We read with interest the article entitled “Tensor Fasciae Latae Perforator Flap: Minimizing Donor-Site Morbidity in the Treatment of Trochanteric Pressure Sores,”1 in which the authors recognized the ascending branch of the circumflex femoral artery as the unique source of vascularization of the tensor fasciae latae muscle in 100 percent of the dissected legs. We performed a review of the related literature using plastic surgical journals and PubMed as the main sources of information. Among these articles, we found an important discordance about the identification of the main source of this muscle. Koshima et al.2 described the transverse branch of the lateral circumflex femoral system as the primary vascular supply of the tensor fasciae latae muscle; Kimura,3 in agreement with Ishida et al.,1 recognized the ascending branch of the lateral circumflex femoral artery as the main source of the muscle. Rifaat and Abdel Gawad,4 in accordance with Koshima et al.,2 found the transverse branch of the circumflex femoral artery to be the main source of all of their flaps (n = 12). In an ongoing cadaveric dissection study, we have dissected 31 lower limbs injected with latex. We found the tensor fasciae latae muscle to be supplied in 74 percent from the ascending branch of the lateral circumflex femoral artery and in 13 percent of the sites from the transverse branch of the lateral circumflex femoral artery; in another 13 percent, the artery supplying the tensor fasciae latae was found to arise directly from the common femoral artery or from the deep femoral artery. In four thighs we noticed a secondary arterial supply nourishing the tensor fasciae latae muscle by arising from either the ascending or the descending branch or directly from the femoral artery (Fig. 1).Fig. 1.: Left side of the groin of an injected cadaver in which the source vessels to the tensor fasciae latae have been dissected. F.V., femoral vein; F.A., femoral artery; A.B., ascending branch of the lateral circumflex femoral artery; arrow, secondary source from the femoral artery.The variability about the origin and branching pattern of the lateral circumflex femoral artery has already been reported.5 The aim of this short report about the main source of the tensor fasciae latae flap (as a muscular, musculocutaneous, or perforator flap) is to invite surgeons to exercise caution during the deep dissection of the pedicle, as its vascular supply presents a higher variability than previously reported. Stefano Cotrufo, M.D. Joerg Dabernig, M.D. Canniesburn Plastic Surgery Unit Glasgow Royal Infirmary Glasgow, United Kingdom Integrated Biological and Life Sciences Section for Human Anatomy University of Glasgow Glasgow, United Kingdom Department of Surgical and Perioperative Science Section for Hand and Plastic Surgery University Hospital Umea, Sweden Department of Integrative Medical Biology Section for Anatomy Umea University Umea, Sweden ACKNOWLEDGMENT This research was sustained by the Steven Forrest Charitable Trust.