Branch Of Femoral Artery Research Articles

Distally based anterolateral thigh flap pedicled on the oblique branch of the lateral circumflex femoral artery

Background: A distally based anterolateral thigh (dALT) flap is an alternative option for reconstructing defects around the knee. This article presents our clinical experience with the use of the dALT flaps based on the oblique branch of the lateral circumflex femoral artery (LCFA) to reconstruct defects in the genicular and popliteal regions. Methods: Between 2008 and 2016, seven patients (4 males and 3 females, between 3–58 years old, mean =34 years) underwent reconstruction of defects around the knee using a dALT flap based on the LCFA oblique branch. Defect etiologies included malignant neoplasm (3 cases) and post-burn scar contracture (4 cases). Results: Reconstruction was successfully performed in all patients. The average flap size was 16.3 cm long (range, 9–24 cm) and 7.3 cm wide (range, 6–8 cm), while the mean pedicle length was 17.7 cm (range, 12–22 cm). The oblique branches originated from the LCFA descending branch in 6 patients and the transverse branch in one patient. One patient had a severely hypoplastic LCFA descending branch and thus the flap was based on the rectus femoris branch. In another patient, the pedicled dALT flap was converted to a free flap because the oblique branch originated from the transverse branch. All flaps survived without any major complications. Conclusions: Our experience demonstrated that we can reliably raise a dALT flap based on the oblique branch when it arises from the LCFA descending branch and sends cutaneous perforators to the anterolateral thigh region.

Is the Oblique Branch a Preferable Vascular Pedicle for Anterolateral Thigh Free Flaps?

The oblique branch of the lateral circumflex femoral artery is considered an alternative vascular pedicle of the anterolateral thigh (ALT) flap. However, the oblique branch has several advantages over the descending branch. A total of 61 consecutive ALT free flaps were harvested according to Yu's ABC system. Vascular pedicle dimensions and length, artery course, perforator origins, and flap harvest time with the oblique branch or the descending branch were recorded. We classified the ALT flaps with oblique branches into three types according to the origin of perforator B. Type I flaps were those where perforator B originated from the descending branch. Type II flaps were those without perforator B. Type III flaps were those where perforator B originated from the oblique branch. The mean ± standard deviation (SD) diameter of the oblique branch at its origin was 1.68 ± 0.51 mm, with an average ± SD pedicle length of 12.92 ± 3.7 cm, while that of the descending branch was 2.27 ± 0.49 mm and 18.73 ± 5.14 cm, respectively. The percentage of septocutaneous perforators from the oblique branch was 35.59%, while that from the descending branch was 15.38%. The flap harvest time with the oblique branch was 33.73 ± 11.68 minutes, while that of the descending branch was 52.27 ± 7.21 minutes. Based on the origin of perforator B, 7 cases had type I ALT flaps, 4 had type II ALT flaps, and 10 had type III ALT flaps. Various ALT flaps based on the oblique branch were harvested, and good clinical results were achieved. The oblique branch is sufficiently large and can be reliably used as the flap pedicle. It may be the preferred vascular pedicle for ALT free flaps.

Emergency Transarterial Embolization in Postoperative Hip Bleeding: Indications, Techniques, and Results in a Retrospective Cohort

BackgroundThe aim of this study is to report the results of transarterial embolization (TAE) in the setting of postoperative bleeding after hip surgery. MethodsWe retrospectively evaluated 40 patients (male:female = 15:25, median age = 68 years) who underwent TAE from 2006 to 2016: 77.5% underwent total hip arthroplasty, 20% open reduction internal fixation, and 2.5% external fixation. Preangiographic multidetector computed tomography angiography was performed in 20 (49%) cases, and 9 of them showed arterial extravasation. Twenty-seven TAEs were performed within a week from surgery; active bleeding was seen in 33 (80.5%) angiograms. Gelatin sponge, microparticles, coils, n-butyl cyanoacrylate, and combinations of them were used as embolic materials. ResultsBleeding was controlled in all cases. The most frequently embolized arteries were branches of the deep femoral artery (n = 17). Permanent embolization agents (microparticles, coils, n-2-butyl-cyanoacrylate) were used in 88% of cases; temporary agents (gelfoam) in 12%. One procedure was complicated by arterial dissection. Hospital discharge averaged 20 days post-TAE (median = 17, range = 3-104). One-month survival rate was 97.5%. One patient died of ischemic bowel perforation. ConclusionTAE is safe and effective in stopping the bleeding of the hip region and should be performed early, to avoid irreversible ischemic damage. Multidetector computed tomography angiography can be used to confirm doubtful evidence of ongoing bleeding. Several embolic materials can be used, each one offering different advantages. Low complication and mortality rates were observed. TAE seems to be the ideal first-line intervention when postoperative bleeding of the operated hip is detected.

Distally based anteromedial thigh flaps pedicled on the rectus femoris branch of the lateral circumflex femoral artery for reconstruction of soft-tissue defect of the knee

Anteromedial thigh flaps are far less clinically appealing than their anterolateral counterparts, and are occasionally considered as an alternative to the anterolateral thigh flap. Herein, we report the study of soft-tissue defects reconstruction in the knee using a distally based anteromedial thigh flap pedicled on the rectus femoris branch of the descending branch of the lateral circumflex femoral artery. Between July 2008 and September 2016, a distally based anteromedial thigh flap was used to reconstruct soft-tissue defects of the knee in 5 patients (3 males, 2 females; age range at surgery 4-55 years old). The perforating vessels supplying anteromedial thigh were derived from the rectus femoris branch of the lateral circumflex femoral artery. The rectus femoris branch shared a common trunk with the descending branches of the lateral circumflex femoral artery. Defect etiologies included malignant neoplasms in 2 cases and post-burn scar contracture in the remaining 3 cases. The average flap size was 19.6 × 9.2 cm (range: 15-24 × 6-12 cm). There was no flap loss. Postoperative muscle weakness occurred in one case. The average follow-up time was 17.8 months (range: 5-36 months). No recurrence of tumor or scar contracture was noted. Distally based anteromedial thigh flaps pedicled on the rectus femoris branch of the descending branch of the lateral circumflex femoral artery may serve as an alternative option to the distally based anterolateral thigh flap for soft-tissue defect reconstruction of the knee.

A True Aneurysm of Perforating Branch of the Deep Femoral Artery Treated by Surgery Using a Posterior Approach

A True Aneurysm of Perforating Branch of the Deep Femoral Artery Treated by Surgery Using a Posterior Approach

Intraoperative perforators of personalized designed KISS flap of the descending branch of the lateral circum-flex femoral artery

Objective To summarize the individualized design of perforating branches in the KISS flap of the descending branch of lateral femoral circumflex artery and improve the survival rate of flap. Methods From Septem-ber, 2012 to June, 2016, the individualized design KISS flap of perforating branches of lateral femoral circumflex artery was used to repair the soft defect in arms and legs in 20 cases, which contained 12 males and 8 females aged from 23 to 71 years old with an average of 48 years. The wounds in upper limb and wrist were 16 cases, and in instep and lower ex-tremity wounds were 4 cases. The areas of tissue defect were ranged from 8.5 cm×12.0 cm to 12.0 cm×23.0 cm. The area of flap ranged from 5.0 cm×8.0 cm to 8.0 cm×14.0 cm. Donor sites were sutured directly. Postoperative follow-up was done termly. Results All flaps survived without vascular crisis. The wounds and incisions at donor sites were the pri-mary healing. Seventeen cases were followed-up 6 to 24 months (average, 18 months) . The color and texture of the flaps were good, and the appearance was satisfactory. The donor site of the flap only left linear scar. Conclusion Designed KISS flap according to diameter of the perforator artery in the operation can improve the survival rate of the flap. The de-sign of the KISS flap is more flexible and reliable, which is worthy of promotion. Key words: Lateral femoral circumflex artery, descending branch; KISS flap; Wound repair; Personal-ized design

Feasibility of a bone and soft tissue chimeric anterolateral thigh free flap? Anatomic study and report of two cases for oral cavity reconstruction

The anterolateral thigh flap (ALT) is a workhorse for a spectrum of reconstructive problems including head and neck defects. Its versatility as a chimeric flap employing a variety of soft tissues with a robust pedicle is useful for three-dimensional defects. The authors investigated the anatomical relationship between the vascular supply to the ALT and anterior femur. We studied 16 fresh cadaver limbs to identify the typical branching patterns to the femur off the descending branch of the lateral circumflex femoral artery. These patterns can facilitate dissection of this type of chimeric ALT. The authors have integrated a bone component of vascularised femur in this flap off the lateral circumflex femoral artery system to address oral cancer defects in two patients. A retrospective review of these cases correlating with the anatomic study was undertaken. Both patients had recurrent disease with limited donor site options. Both had extensive floor of mouth and tongue defects as well as small mandible defects of 2 cm. Both went on to heal at the donor and recipient sites at 32 months' follow-up.

Abdominal Wall Reconstruction Using an Anterolateral Thigh Free Flap for a Large Abdominal Wall Defect

Objective: To present a complicated case of abdominal wall reconstruction after tumor extirpation using an anterolateral thigh free flap. Methods: This is a report of a case managed at the Philippine General Hospital last September 2016. Results: A 25-year-old male, diagnosed case of recurrent colon adenocarcinoma, underwent wide excision of recurrent abdominal wall tumor with fistula, resulting to 15cm x 30cm full thickness soft tissue abdominal wall defect with exposed bowels. A free anterolateral thigh fasciocutaneous flap was designed and elevated to cover the abdominal wall defect. Recipient vessels (contralateral deep inferior epigastric artery and veins) were anastomosed with donor vessels (descending branch of lateral circumflex femoral artery and veins). The donor site was closed with split thickness skin grafting. Conclusion: The free anterolateral thigh flap allows for coverage of complicated recurrent abdominal wall malignancies, allowing for a single-stage surgery, with little donor site morbidity and shorter hospital stay. Key words: free tissue transfer flap, microsurgical free flap

Application of the descending branch of the lateral circumflex femoral artery in the coronary artery bypass grafting operation

Objective: To investigate the technical method for harvesting and application of the descending branch of the lateral circumflex femoral artery (DBLCFA) in the coronary artery bypass grafting (CABG) operation. Methods: Between December 2016 and April 2017, 19 patients were arranged to use DBLCFA and got CT angiography (CTA) of pelvic and femoral arteries pre-operative at Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Finally, DBLCFA was harvested in 16 patients (including 2 female patients, with a mean age of (47.4±8.5) years) through the anterior thigh incision (13 cases on the left side, 3 cases on the right side). The CABG operations were performed under the cardiopulmonary bypass support (in 10 cases) or under the beating heart condition (in 6 cases), and the DBLCFA conduit was used combining with bilateral internal thoracic artery (in 12 cases), radial artery (in 7 cases) and saphenpous vein (in 3 cases). Results: Due to anatomical variations such as short length and anomalous branch, or due to silent atherosclerosis stenosis of femoral artery, DBLCFA in 3 patients was considered inappropriate for use and was not harvested after CTA examination. In another 16 patients, DBLCFA was safely and quickly harvested and successfully used. On average, 3.4±0.6 anastomosis was built up in CBAG, no adverse effects were exhibited. The length of the harvested DBLCFA was (10.3±1.8) cm, with average lumen diameter of (1.9±0.5) mm. DBLCFA was used as free graft in 15 patients (7 to the first diagonal branch, 6 to the ramus intermedius branch, 1 to the left anterior descending branch and 1 to the second obtuse marginal branch). In 1 patient, the DBLCFA was firstly implanted end-to-side to the internal thoracic artery as a "Y" type composite graft, and then anastomosed to the third obtuse marginal branch. Conclusions: The descending branch of the lateral circumflex femoral artery is an option conduit in CABG. It can be harvested easily and safely. However, pre-operative CTA examination is necessary to exclude the variation and appropriate strategy for graft establishment should be considered during the operation.

Clinical cognition of anterolateral femoral skin flap with high cutantous artery branches

Objective To recognize relationship between high cutantous artery branches and descending branch of lateral femoral circumflex artery artery, and to investigate blood supply of anterolateral thigh flap in clinical. Methods Retrospective analysis 152 cases of anterolateral thigh flap from November, 2003 to December, 2016. It contains cutting with descending branchs in 99 cases, cutting with lateral branchs in 43 cases, union of them in 8 cases and high cutantous artery branches in 2 cases. Results The flaps survival in 147 cases, cutting necrosis in 3 cases and partly necrosis in 2 cases. Descending and lateral branchs were both dominance neurovascular bundle of vastus lateralis muscle, independently or commonly dominate skin of anterolateral thigh, occurrence rate was 33.5%. Conclusion The descending branch of lateral femoral circumflex artery include lateral branch, all of which are neurovascular bundles, supply anterolateral thigh muscle, and divid into some perforator branches crossing musle to anterolateral thigh skin subsequently, which constitute the anatomical functional unit. High cutantous artery branche is one of all of branches, its origin lies hight and arise from lateral branch. Key words: Anterolateral thigh flap; Lateral femoral circumflex artery, descending branch; High cutantous artery branches; Perforators

Application of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degloved injury of foot

Objective To assess preliminary clinical efficacy of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degloved injury of forefoot or midfoot. Methods From March 2013 to December 2015, eight patients with degloved injury of forefoot or midfoot were retrospectively analyzed by case series study. They were seven males and one female, with age range of 18-51 years (mean, 34.5 years). The foot skin defect area ranged from 18 cm×12 cm to 13 cm×10 cm. All patients underwent computed tomography angiography (CTA) in lower extremities preoperatively. The CTA data were entered into Mimics 15.0 software in DICOM format. Based on perforating condition of descending branch of lateral femoral circumflex artery and the size of foot defect, one thigh was chosen for three dimensional reconstruction of anterolateral thigh flap. The flap size ranged from 24 cm×9 cm to 19 cm×7 cm. All reconstructive surgeries were performed secondarily. Patients were all at II stage recovery. The survival of flaps and healing status of flap donor sites were observed in one month after surgery. The number of debulking flaps was recorded. The appearance of flaps, shoe wearing, gait and related complications were recorded. Results The follow-up was 10-21 months (mean, 15.5 months). All flaps survived uneventfully, and all donor sites were sutured directly. Three patients had twice debulking procedures, three patients had one debulking procedure, and two patients had no debulking. At the last visit in follow-up, the color and texture of flaps were good. All patients were able to wear shoes normally, two patients remained mild abnormal gait, and one patient presented superficial ulcer at the medial of the forefoot. Conclusions Double skin paddle anterolateral thigh flap for reconstruction of degloved injury of forefoot or midfoot can prompt wound healing and decrease complications. Digital assisted technology is an excellent supplementary method in double skin paddle anterolateral thigh flap for reconstruction of degloved injury of foot, which makes precise preoperative planning and intraoperative accurate cutting. Key words: Foot injuries; Soft tissue injuries; Surgical flaps; Computer-aided design

Emergency repair of upper extremity large soft tissue and vascular injuries with flow-through anterolateral thigh free flaps

Background/ObjectivesComplex extremity trauma commonly involves both soft tissue and vascular injuries. Traditional two-stage surgical repair may delay rehabilitation and functional recovery, as well as increase the risk of infections. We report a single-stage reconstructive surgical method that repairs soft tissue defects and vascular injuries with flow-through free flaps to improve functional outcomes. MethodsBetween March 2010 and December 2016 in our hospital, 5 patients with severe upper extremity trauma received single-stage reconstructive surgery, in which a flow-through anterolateral thigh free flap was applied to repair soft tissue defects and vascular injuries simultaneously. Cases of injured artery were reconstructed with the distal trunk of the descending branch of the lateral circumflex femoral artery. A segment of adjacent vein was used if there was a second artery injury. Patients were followed to evaluate their functional recoveries, and received computed tomography angiography examinations to assess peripheral circulation. ResultsTwo patients had post-operative thumb necrosis; one required amputation, and the other was healed after debridement and abdominal pedicle flap repair. The other 3 patients had no major complications (infection, necrosis) to the recipient or donor sites after surgery. All the patients had achieved satisfactory functional recovery by the end of the follow-up period. Computed tomography angiography showed adequate circulation in the peripheral vessels. ConclusionsThe success of these cases shows that one-step reconstructive surgery with flow-through anterolateral thigh free flaps can be a safe and effective treatment option for patients with complex upper extremity trauma with soft tissue defects and vascular injuries.

Variations in the Anterolateral Thigh Flap's Vascular Anatomy in African Americans.

Variations in anterolateral thigh (ALT) arterial anatomy are well documented. Ethnicity is a known risk factor for vascular variation in several organ systems, but its impact on ALT anatomy has not been studied. Anecdotally, we observed frequent ALT arterial variation in African American (AA) patients. We thus hypothesized that AA patients have higher rates of anomalous branching. A total of 277 computed tomography angiograms (513 lower extremities) captured between May 1, 2013 and May 31, 2015 at a tertiary academic medical center were retrospectively analyzed to determine ALT arterial branching. Patient records were examined to ascertain demographics. Data were analyzed using descriptive statistics and multinomial logistic regression. Males comprised 84.5%. Ethnic distribution was 55.2% AA and 36.5% Caucasian. The descending branch of the lateral circumflex femoral artery (dLCFA) originated from non-LCFA arteries (deep femoral, common femoral, or superficial femoral arteries) in 18.9% of Caucasian versus 9.1% of AA (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.33-3.93, p < 0.01). An oblique branch was identified in 41.1% of Caucasian versus 51.9% of AA (OR: 1.56; 95% CI: 1.08-2.24, p = 0.02). Ethnicity was the only driving factor of dLCFA and oblique branch of the LCFA (oLCFA) anatomy (Wald chi-square: 14 and 11, p = 0.03 and 0.02, respectively). Ethnicity significantly affects ALT arterial anatomy. AA are more likely to have classical dLCFA branching with a fourth oLCFA branch. A flap with an unrecognized oLCFA-dominant supply places patients at a higher risk for flap failure and loss. We recommend preoperative imaging before undertaking an ALT flap reconstruction.

Retrograde Cement Extrusion into Femoral Nutrient Vessels Following Uncomplicated Total Hip Arthroplasty

The present concepts in Total Hip Arthroplasty advocate mechanical cement interlock with trabecular bone utilising the third-generation cementing technique. However, the force generated can easily reach peak pressure of 122 kPa to 1500 kPa, leading to extrusion of cement through nutrient foramina into femoral cortex into nutrient vessels, henceforth the retrograde arteriovenogram. A 76 years old lady who premorbid ADLindependent had a fall and sustained a closed right neck of femur fracture. She underwent cemented right total hip arthroplasty. Acetabulum cup of 47mm and femoral stem size 1 was utilized. Femoral canal was prepared and medullary cavity plug inserted before retrograde cement was introduced using the cementing gun. Intraoperative no complications were noted. This case has been followed up to a year with no adverse effect. The post-operative radiograph demonstrated a linear radio-opacity communicating with the posterior aspect of the femoral shaft which continues proximally and medially for approximately 10cm. Its uniformity in shape and position corresponds to the vascular supply of proximal femur. In Farouk et al cadaveric study, nutrient vessel arises in 166 ± 10 mm from the greater trochanter and is a branch of the second perforating artery from the deep femoral artery. Knight et al infer that retrograde cement extrusion occurs in female patients with small stature and small endosteal canal. Cement extrusion unlikely will influence the long haul survival of prosthesis as shown in the radiograph that cement is well pressurized to interlock with the endosteal bone. Moreover, because of extensive anastomoses of perforating branches of the deep femoral artery, segmental obliteration of nutrient artery alone is unlikely to lead to vascularity issues. Cement extrusion into the nutrient foramen is a vital differential in presence of posterior medial cement in the diaphysis of the femur following total hip replacement. This is to differentiate from extra osseous extrusions due to the iatrogenic breach of the femoral cortex suggesting periprosthetic fracture which affects the long term survival of prosthesis.

Multidetector Computed Tomography (CT) Analysis of 168 Cases in Diabetic Patients with Total Superficial Femoral Artery Occlusion: Is It Safe to Use an Anterolateral Thigh Flap without CT Angiography in Diabetic Patients?

The superficial femoral artery (SFA) is the most common site of lower extremity atherosclerosis, and collateral vessels from the deep femoral artery (DFA) play an important compensatory role between the iliofemoral segment and the popliteal artery. We examined SFA occlusion and collateral vessel developments in patients with diabetes mellitus using computed tomography (CT) angiography. We also compared the collateral systems from the DFA and the descending branch of the lateral circumflex femoral artery (dbLCFA) in the case of SFA occlusion. We retrospectively reviewed 1,316 sets of CT angiographic data collected from 673 patients with diabetes between 2008 and 2010. The degree of stenosis in each segment of the proximal and distal SFA and the number and size of collateral vessels originating from the DFA and dbLCFA were measured using established scoring systems. In cases where the SFA was occluded, the numbers of collateral vessels originating from the DFA and the dbLCFA vessel were compared. The mean occlusion rate of the SFA was 15.6%. We noted that collateral vessels from DFA and dbLCFA were the main circulatory route in cases of occlusions of the SFA. More collateral vessels developed from the DFA than from the dbLCFA. Overall, 0.6% of the patients had only collateral systems from the dbLCFA. When planning to use anterolateral thigh free flaps in diabetic patients with suspected SFA total occlusion, thorough investigations of the peripheral vessels are essential.

Abstract: Variations in the Anterolateral Thigh Flap’s Vascular Anatomy in African Americans

INTRODUCTION: Variations in anterolateral thigh (ALT) arterial anatomy are well documented. Ethnicity is a known risk factor for vascular variation in several organ systems, but its impact on ALT anatomy has not been studied. Anecdotally, we observed frequent ALT arterial variation in African American (AA) patients. We thus hypothesized that AA patients have higher rates of anomalous branching. METHODS: 277 computed tomography angiograms (513 lower extremities) captured between May 1, 2013 and May 31, 2015 at a tertiary academic medical center were retrospectively analyzed to determine ALT arterial branching. Patient records were examined to ascertain demographics. Data were analyzed using descriptive statistics and multinomial logistic regression. RESULTS: Males comprised 84.5%. Ethnic distribution was 55.2% AA and 36.5% Caucasian. The descending branch of the lateral circumflex femoral artery (dLCFA) originated from non-LCFA arteries (deep femoral, common femoral, or superficial femoral arteries) in 18.9% of Caucasian vs. 9.1% of AA (OR 2.28; 95% CI: 1.33–3.93, p < 0.01). An oblique branch was identified in 41.1% of Caucasian vs. 51.9% of AA (OR 1.56; 95% CI: 1.08–2.24, p = 0.02). Ethnicity was the only driving factor of dLCFA and oLCFA anatomy (Wald Chi-square 14 and 11, p = 0.03 and 0.02, respectively). CONCLUSION: Ethnicity significantly affects ALT arterial anatomy. AA are more likely to have non-classical dLCFA branching and a fourth oLCFA branch. A flap with an unrecognized oLCFA dominant supply places patients at higher risk for flap failure and loss. We recommend pre-operative imaging prior to undertaking an ALT flap.

Dual Vascular Free Anterolateral Thigh Flap.

Background:The optimum number of microvascular anastomoses for safe free tissue transfer is controversial. Although the case for 2 venous anastomoses versus 1 anastomosis has been argued, the use of an additional arterial anastomosis has not been examined in detail.Methods:Twelve patients who underwent 2 arterial anastomoses for a free flap transfer were identified retrospectively from the medical records of patients undergoing reconstruction for head and neck cancer. The free flaps were limited to anterolateral thigh (ALT) flaps.Results:All flaps survived. Complications included venous thrombosis (n = 1), reexploration (n = 1), and leakage (n = 3). The vascular patterns of dual-arterialized ALT flaps were classified into 3 groups. Types 1 and 2 were ALT flaps that had 2 vascular sources from the descending and lateral branches of the lateral circumflex femoral artery. The number of accompanying veins differed between type 1 (3 veins) and type 2 (2 veins). Type 3 differed from a conventional ALT flap nourished by the descending branch of the lateral circumflex femoral artery (1 vein) by the addition of anastomosis of an artery branching from the descending branch to the vastus medialis muscle. The total operation times for these 3 types of ALT were similar.Conclusions:An additional arterial anastomosis to the free cutaneous flap did not cause any congestion or disturb the balance between inflow and outflow. If the surgeon considers that the first arterial anastomosis is unreliable, an additional anastomosis might be an option in ALT transfer.

Arterial Topographic Anatomy Near the Femoral Head-Neck Perforation with Surgical Relevance.

Knowledge of the vascular supply of the femoral head is crucial for hip-preserving surgical procedures. The critical area for reshaping cam deformity is at the retinacular vessel penetration, an area with ill-defined topographic anatomy. We performed a cadaver study of the extension of the lateral retinaculum near the head-neck junction, distribution of the arterial vascular foramina, and initial intracapital course of these vessels. In 16 fresh proximal parts of the femur without head-neck deformities, the deep branch of the medial femoral circumflex artery was injected with gadolinium for magnetic resonance imaging (MRI) sequences to identify arterial structures. We found a mean number of 4.5 arterial foramina, showing a predominance from 10 to 12 o'clock. The retinaculum extended 20 mm from 1 to 10 o'clock. The surface distance from the cartilage border to the vascular foramina under the synovial fold was 6.5 mm, and the depth from the same cartilage border to the initial intraosseous vessel pathways was 5.3 mm. The data add further precision to the arterial topography at the retinacular foramina, an area that is crucial for the perfusion of the femoral head. It may overlap with the area of anterolateral cam deformity and plays a role in choosing the cuts for subcapital and intracapital osteotomies. The information is taken from normal hips and may not be directly applicable to the deformed hip. Nevertheless, it is a prerequisite for a surgeon to understand the normal anatomy and use those boundaries to prevent mistakes during intra-articular joint-preserving hip surgical procedures.

Results from the surgical resection of severe heterotopic ossification of the hip: a case series of 26 patients

Surgical resection of heterotopic ossification (HO) around the hip joint is often challenging. The aim of this study is to evaluate the clinical and radiological outcomes following surgical resection of Brooker's type III and IV HO of the hip. We retrospectively reviewed clinical and radiological data, between November 2006 and January 2013, of all patients who underwent surgical resection of severe HO of the hip. Brooker's grading, range of motion and the Harris Hip Score before and after surgery were recorded in all cases. The combined radiation (700cGy preoperatively) and indomethacin regimen was used to prevent heterotopic ossification recurrence. Twenty-six patients (22 males and 4 females) were included in our study. Mean patient age was 47.38years (range 24-72). The HO was graded as Brooker grade III in 3 patients (11.5%) and Brooker grade IV in 23 patients (88.5%). Mean time interval between HO development and resection was 40.8months (range 13-156months). All patients had CT scans prior to surgery. Mean follow-up was 31.4months (range 24-40months). There was no severe HO recurrence. Complications included one intraoperative injury of a femoral artery branch, one intraoperative femoral neck fracture treated with intramedullary nailing, one sciatic nerve injury and one superficial infection treated conservatively. Surgical resection of severe HO of the hip along with preoperative radiation and indomethacin provides excellent results; however, the complication rate is relatively high. Careful evaluation of the preoperative CT scan and wide exposure are required in order to identify all the involved neurovascular structures.

Classification and Application of the Distally-Based Thigh Flap Based on the Lateral Circumflex Femoral Artery System

The lateral circumflex femoral artery system with its anatomical variations is a common source vessel for numerous thigh flaps. However, the anatomic variations of the distally based thigh flaps have not been well classified. Between July 2008 and July 2016, 19 patients (13 men and 6 women; age range, 3-58 years; mean, 27.5 years) underwent reconstruction of defects around the knee using distally based thigh flaps. Defect etiologies included malignant neoplasm (6 cases) and post-burn scar contracture (13 cases). The distally based thigh flaps were raised based on perforating vessels originating from the descending, oblique, rectus femoris branches of the lateral circumflex femoral artery. The average flap size was 17.7 × 8.4 cm (range, 9-24 cm × 6-13 cm), whereas the mean pedicle length was 16.2 cm (range, 8.5-25 cm). The flap's perforating vessels originated from the descending branch in 6 patients, the oblique branch from the descending branch in 7 patients, the rectus femoris branch in 5 patients, and the oblique branch from the transverse branch in 1 patient. All flaps were pedicle flaps except 1 based on the oblique branch from the transverse branch that was converted to a free flap. All flaps survived in its entity. Our experience demonstrated that a distally based thigh flap can be reliably raised using perforating vessels from different branches of the lateral circumflex femoral artery.