Branch Of Lateral Circumflex Femoral Artery Research Articles

Defect Reconstruction Using the Propeller Flaps Based on the Perforators Derived From the Lateral Circumflex Femoral Artery System.

Although propeller flaps are a useful option for soft tissue defect reconstruction, reports based on the perforators of the lateral circumflex femoral artery (LCFA) are rare. We aimed to present our experience in defect reconstruction using the propeller flaps based on perforators from different branches of LCFA and apply these flaps in soft tissue defect reconstruction of the lower extremities. Twenty nine patients (32 flaps) underwent defect reconstruction using propeller flaps based on the perforator of the LCFA. Defects were located from the groin to the proximal leg. According to the source vessels from which the perforator originated, flaps were categorized into types I, II, III and IV, which represented perforators from the transverse, descending, oblique, and rectus femoris branches, respectively. Type II flaps were subdivided into types IIa and IIb flaps based on antegrade and reverse flows of the descending branch. Flap sizes ranged from 12 × 6 cm to 30 × 15 cm (average, 22.69 × 9.19 cm) with the length of the vascular pedicle ranging from 3 to 7 cm (average, 4.86 cm). Flaps were rotated from 60° to 180° (average, 144.06°). There were 3 type I, 10 type IIa, 4 type IIb, 13 type III and, and 2 type IV flaps. Twenty-nine flaps survived after surgery. Total flap necrosis and venous congestion of the distal flap portion occurred in 1 and 2 patients, respectively. Reconstruction using propeller flaps based on perforators of the LCFA is a safe, reliable, and versatile option for defect reconstruction of the lower extremities; however, it requires meticulous surgical dissection and patience.

Clinical application of the lateral branch of lateral circumflex femoral artery in the anterolateral thigh perforator flap

Objective To investigate the feasibility and technique of using the anterolateral thigh perforator flap pedicled with the lateral branch of the lateral circumflex femoral artery (LBLCFA) to repair soft tissue defect of extremities. Methods Eighty-six cases of anterolateral thigh perforator flap transplantation were performed from May, 2014 to May, 2018. A total of 37 cases of soft tissue defect of extremities were treated by anterolateral thigh perforator flap used the LBLCFA as vascular pedicle, of which there were 19 cases of upper limbs and 18 of lower limbs. There were 27 cases of defects caused by trauma, and 10 by soft tissue tumor resection. The flaps were designed centering around the point proximal to the midpoint of the iliac-patellar line. The dimensions of soft tissue defect were from 9.0 cm×6.0 cm to 26.0 cm×10.0 cm, and the flap were from 10.0 cm×7.0 cm to 27.0 cm×11.0 cm. The length of vascular pedicle ranged of 7.0-13.0 cm, with an average of 11.5 cm. The donor sites were directly sutured. All of the patients were followed-up regularly in the outpatient department. Results All the flaps survived and the donor sites were primarily healed. Of these 37 cases, 2 trauma patients and 2 patients treated with local radiotherapy had poor wound healing, but still healed after multiple dressing changes. All the patients were followed-up for 3-26 months, with an average of 13 months. The texture, color and elasticity of the flap were similar to the surrounding tissue of the recipient sites, while only a linear scar remained at the donor sites. Ten tumor patients were treated with routine radiotherapy and chemotherapy after the repairation; there was no tumor recurrence during the follow-up period. Conclusion The LBLCFA gives off a relatively large and thick perforator proximal 5.0-7.0 cm of the iliac-patellar line, which locates in the upper lateral side, travels parallel to the vastus lateralis, and give off the skin and muscular perforators. The lateral branch can be used as pedicle to make into perforator flap or chimeric flap, which provides a novel selection of vascular pedicel for anterolateral thigh perforator flap. When the descending branch does not provide a thick and large perforator, the LBLCFA has important practical value and is worth utilizing in the clinic. Key words: Lateral branch, lateral circumflex femoral artery; Anterolateral thigh flap; Tissue transplantation; Microsurgical technique

Repair of large and deep skin and soft tissue defects around the knee joints with free latissimus dorsi musculocutaneous flaps

To investigate the clinical efficacy of free latissimus dorsi musculocutaneous flaps in repairing large and deep skin and soft tissue defects around the knee joints. Twenty-five patients with large and deep skin and soft tissue defects around the knee joints were hospitalized from March 2005 to March 2014. The area of defects around the knee joints ranged from 10 cm × 8 cm to 43 cm × 23 cm. The free latissimus dorsi musculocutaneous flaps were used to repair the defects, with the area ranging from 12 cm × 10 cm to 45 cm × 25 cm. The thoracodorsal artery and its concomitant vein of the musculocutaneous flap were anastomosed to the descending branch of the lateral circumflex femoral artery and its concomitant vein respectively to reconstruct blood supply. Split-thickness skin grafts around the flap donor sites were harvested to cover the muscle surface of the musculocutaneous flaps. The flap donor sites were closed directly with suture, and the skin donor sites were healed by dressing change. All the 25 flaps survived without vascular crisis. The flaps were in satisfactory appearance. The flap donor sites were healed with linear scar. All the patients were followed up for 3 to 6 months. At last, they were able to stand up and walk. The free latissimus dorsi musculocutaneous flap transplantation is an effective treatment for the repair of large and deep soft tissue defects around the knee joints, and the descending branch of lateral circumflex femoral artery and its concomitant vein are the appropriate recipient vessels.

Clinical analysis of risk factors of the patency of the descending branch of the lateral circumflex femoral artery

Many studies have provided anatomical statistics of the descending branch of lateral circumflex femoral artery (LCFA) through its use as the pedicle of anterolateral thigh (ALT) flaps. However, most of the results from these studies were acquired during surgeries or from cadavers. Therefore, this study has studied the descending branch of LCFA in patients with underlying diseases or risk factors using lower extremity angiography, and how such risk factors and the degree of stenosis in other arteries affect the patency and stability of the descending branch. The subjects of retrospective study were 89 legs from 49 patients who had received lower extremity angiography. Risk factors included age, BMI, diabetes, hypertension, tobacco use, hyperlipidemia, cardiac status, carotid status, renal disease, pulmonary status, and history of lower limb amputation. Analysis of the degree of stenosis in the descending branch of LCFA in regard to each risk factor have shown that hypertension, pulmonary function, history of lower limb amputation, and the total score of 11 risk factors were statistically significant. Also, in the correlation study of lower limb arteries, there was a significant correlation with the degree of stenosis in the posterior tibial artery, but not so in others. Therefore, when planning a flap surgery using the descending branch of LCFA, one needs to run imaging tests such as angiography to check arterial patency in patients with hypertension, impaired pulmonary function, and history of lower limb amputation.

The hemodynamics study and application of the reversed descending branch of lateral circumflex femoral artery

To investigate the hemodynamics evidence of the descending branch of lateral circumflex femoral artery in a reversed way. To explore the clinical result of using the reversed descending branch of the lateral circumflex femoral artery as the receipt artery for free flaps for reconstruction of the leg soft-tissue defect. From October 2005 to February 2012, 38 patients with severe leg soft-tissue defects were treated. The proximal antegrade and retrograde mean artery pressure of the descending branch of the lateral circumflex femoral artery in 16 of 38 patients were recorded during operation. All wounds had osteomyelitis, bone and tendon exposure requiring coverage reconstruction. And there was no recipient artery in the injured lower leg for free flaps in all 38 patients. Reversed descending branches of lateral femoral circumflex arteries were used as recipient arteries for free flaps (free latissimus dorsi flap, free thoracoumbilical flap, and free anterolateral thigh flap) in all patients. The flap donor site was closed directly or with the skin graft. The proximal antegrade mean artery pressure of the descending branch of lateral circumflex femoral artery was(81.6 +/- 12.4) mmHg. The proximal retrograde pressure was(48.2 +/- 10.7) mmHg. The proximal retrograde mean artery pressure was 59.07 percent of the proximal antegrade pressure. The donor skin graft survived and wound healed primarily. After operation, 2 flaps had distal partial necrosis and healing was achieved after dressing change. All the other flaps survived completely without vascular problems. All the patients were followed up for 11 months to 2.5 years (mean, 1.6 years). The flap appearance was satisfactory. The texture and color of flaps in all cases were good. The reverse descending branch of lateral circumflex femoral artery is a reliable recipient artery for the free flaps. It is an easy and simple technique that can be used for reconstruction of the defects in the lower leg, with the reversed descending branch of lateral circumflex femoral artery as recipient artery.

Anatomic analysis of the vascular network and vascular pedicle of the tensor fascia lata flap (angiographic and cadaver study)

Knowing the vascular network and properties of the vascular pedicle is of crucial importance for elevation of the tensor fascia lata (TFL) transpositional or free flap; therefore, the origin of the lateral circumflex femoral artery (LCFA), its diameter at the site of origin, the length of the vascular pedicle, the number of lateral branches, the number of terminal branches and the anastomosis of the LCFA ascending branch are of utmost importance for successful elevation and clinical application of this flap. The study was conducted on clinical (100 angiographic images of the femoral artery) and autopsy (48 preparations) material. The first part of the study comprised analysis of the angiographic images that were used to obtain the information on LCFA. The diameter of LCFA at its origin was measured to be 0.44 cm, while it was 0.33 cm at the origin of ascending branch. The mean value of the diameter at the bifurcation of the terminal branches of ascending branch (inside tensor fascia lata muscle) was 0.24 cm. It has been established that the vascular pedicle of the tensor fascia lata flap (ascending branch of LCFA) is anastomosed with the superior gluteal artery in all cases. Measurement of the tensor fascia lata muscle revealed an average length of 15.91 cm, width of 3.55 cm and thickness of 1.98 cm. Injection of colour-ink into the ascending branch LCFA that enters directly into the TFL muscle was used to measure the extent of the TFL flap vascularization and on the average, the TFL flap was 20.32 cm long and 16.57 cm wide while the surface was 17.52 cm3.