Femoral Artery Perforator Flap Research Articles

Application of thin free lateral femoral circumflex artery perforator flap in repair of scar contracture deformity in hand and foot

To explore the effectiveness of thin free lateral femoral circumflex artery perforator flaps that dissected under the superficial fascia in repair of scar contracture deformity in hand and foot. Between January 2017 and October 2020, 15 patients with scar contracture deformity in hand or foot were admitted. There were 9 males and 6 females; aged 6-42 years, with a median age of 23 years. Scar contracture lasted from 1 to 21 years, with a median of 13 years. There were 11 cases of scar contracture deformities in the hands and 4 cases in the feet, all of which showed different degrees of hand and foot joint dysfunction. After the scar contracture was released, the size of wounds ranged from 6 cm×4 cm to 9 cm×8 cm, including 12 cases with exposure of blood vessels, nerves, or tendons, and 4 cases with tendon defects. A thin free lateral circumflex femoral artery perforator flap that dissected under the superficial fascia was used to repair the wound. The size of flap ranged from 6.0 cm×5.0 cm to 10.0 cm×8.5 cm. Fascia strips were used to reconstruct tendons and the donor sites were sutured directly. The venous vascular crisis occurred in 1 flap, and the flap survived successfully after treatment. The rest flaps survived well, and the wounds healed by first intention. All incisions at donor sites healed by first intention. All patients were followed up 6-12 months after operation, with an average of 9 months. The flaps were in good shape and texture. The functions of the affected hand had been restored to a large extent. According to the upper limb function evaluation standard of the Society of Hand Surgery of the Chinese Medical Association, 7 cases were excellent and 4 cases were good. The deformity of the toe joint of the affected foot significantly improved. No muscular hernia, sensory numbness, or other complications occurred at the donor sites. The thin free lateral femoral circumflex artery perforator flap that dissected under the superficial fascia is an effective method to repair scar contracture deformity of hand and foot with well appearance, good function recovery, and less complication of the donor sites.

Virtual Planning of Profunda Femoral Artery and Superficial Circumflex Iliac Artery Perforator Flaps.

Virtual Planning of Profunda Femoral Artery and Superficial Circumflex Iliac Artery Perforator Flaps.

Le lambeau perforant de l’artère fémorale profonde : une étude anatomique morphométrique

Within the framework of mammary reconstruction, since 2012 when Allen first described it, the profunda femoral artery perforator flap (PAP) takes an important place in the current therapeutic options. This anatomical study aims to analyze the anatomy and morphologic consideration of the PAP: position of the perforating artery; length of the pedicle, area and volume of vascularization. Sixteen flaps were harvested on fresh subjects at the University Department of Anatomy of Rockfeller, Lyon. The first direct cutaneous branch from the deep femoral vessels was located between or through the adductor magnus and gracilis muscles. Pedicle location, diameter, length and position regard to the great saphenous vein were recorded. A flap based on this vessel was designed. Height, width, and surface of the skin paddle were recorded. Three-dimensional computed tomographic angiography was used to analyze the area and volume of cutaneous territory supplied by the studied perforator. On the 16 analyzed flaps, localization of the perforating artery is on average to 8.2cm of the pubic tuber and 3.7cm behind a line connecting the pubic tuber to the internal femoral condyle. The length of the pedicle is on average of 11.7cm and the average area of skin perfused was 94,68cm2. The way of this perforating arterty is primarily through the adductor magnus. On the radiological images of the 8 flaps, the analysis shows an average surface of 111,25cm2 and a mean volume of 325.3cm3. PAP is an interesting therapeutic choice within the framework of a mammary reconstruction. Its surface and its volume associated with a discrete scar make a valid indication within the framework of this surgery.

The thin profunda femoral artery perforator flap for tongue reconstruction.

With the ongoing global epidemic of obesity in the Western countries, thigh flaps such as the profunda artery perforator (PAP) free flap, have been less favorable for glossectomy reconstruction due to large bulk of adipose tissue associated with traditional subfascial harvest. In this article, we present a series of 10 patients who underwent reconstruction with suprafascial PAP free flaps following oncologic tongue resection. Our series included six men and four women with an average age of 53.9 years old (range, 28-71 years). All patients underwent preoperative computed tomographic angiography (CTA) for selection of the most suitable perforator and preoperative design of its customized thickness. Flap elevation was performed at the superficial fascia layer while modifying the plane of dissection according to the specific bulk needs in each case. Flaps survived in nine patients; one flap failed due to vasospasm. Mean pedicle length was 7.4 cm (range, 6-8 cm). Skin paddle dimensions varied between 8 × 6 and 15 × 9 cm. Flaps thicknesses ranged from 0.4 to 3 cm. Functional outcome was evaluated at 6 months follow up: good speech and deglutition functional outcomes relative to extent of resection were observed. The dissection above the superficial fascia layer represents an important refinement to the traditional fasciocutaneous PAP flap. Flap thickness can be tailored to avoid excess of bulk in the medial thigh observed in larger BMI populations.

Application of deep femoral artery third perforating artery flap for reconstruction of soft tissue defect in lower limles

Objective To investigate the feasibility and clinical effects of deep femoral artery third perforating artery perforator flap for reconstruction of soft tissue defect in lower limbs. Methods From September, 2008 to October, 2016, 8 cases of soft tissue defect in lower limbs which were repaired by deep femoral artery third perforating artery perforator flap, including 4 cases of traffic accident trauma, 2 cases of chronic ulcer, 1 case of a fall injury, 1 case of the scar after fracture operation. The area of wounds was 8.0 cm×7.0 cm-19.0 cm×8.0 cm. Seven patients were accompanied by different degrees of infections. The deep femoral artery third perforating artery perforator flap was designed to repair, including 5 cases of pedicled flaps and 3 cases of free flaps. The flap’s appearance, color, texture, infection recurrence and the recovery of lower limb function were recorded at 1, 3, 6, 9 and 12 months followed-up. Results One flap suffered partial necrosis due to cross-zone backflow disorder, the ipsilateral medial sural artery pedicled perforator flap was used to repair. The rest of the flaps survived successfully. Skin graft was used to close the donor site in 1 case, and other donor sites were closed directly. All patients had no postoperative hematoma or secondary infection. The followed-up periods ranged from 2 to 28 months (mean, 8.1 months). All flaps had satisfied appearance and texture. There were no complications such as paresthesia and numbness in the donor sites. And no motion limitations in hip and knee joint of the operated leg. Conclusion Deep femoral artery third perforating artery perforator flap can be used for both free flaps and pedicled flaps, which is a feasible method to repair soft tissue defect in lower limbs. Key words: Perforator flap; Deep femoral artery; Third perforating artery; Lower limb; Soft tissue defect

Application of high frequency color Doppler ultrasound combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap surgery

To investigate the application of high frequency color Doppler ultrasound (HFCDU) combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap graft. Between January 2017 and March 2018, 28 patients with skin and soft tissue defects were treated, including 22 males and 6 females, with an average age of 33.5 years (range, 17-66 years). The causes of injury included 2 cases of scald scar, 7 cases of heavy object crushing injury, 12 cases of traffic accident injury, 4 cases of fall injury, 2 cases of machine injury, and 1 case of infection ulcer. Injury sites included 6 cases of hand and wrist, 12 cases of lower leg, 10 cases of foot. After debridement, the wound area ranged from 6.0 cm×3.5 cm to 24.0 cm×9.0 cm, and all patients were treated with free circumflex femoral artery perforator flap graft. Combo of HFCDU and wide-field imaging navigation were done preoperatively to detect the origin, quantity, course, surface location, hemodynamic characteristics, and the relationship with body area of perforator branch of lateral circumflex femoral artery. According to the perforator information displayed by wide-field imaging of source artery, the dominant perforator was determined to be a pedicle for designed flap. The flap size ranged from 7.0 cm×4.5 cm to 26.0 cm×7.0 cm. The flap donor area was sutured directly. The dominant perforator was successfully detected by HFCDU combined with wide-field imaging in 28 patients before operation. The existence of the perforator was confirmed during operation, and the location was accurate. The course characteristics of the perforate were consistent with the results of wide-field imaging. The grafted flaps survived completely among 27 patients after operation. Necrosis at the edge of the flap was observed in 1 patient, which healed after dressing change. All patients were followed up 3-12 months, with an average of 9 months. All the flaps have good blood supply, good elasticity and shape. The donor areas healed perfectly. Using HFCDU and wide-field imaging navigation for designing of anterolateral thigh perforator flaps can clearly show the characteristics of perforators, hemodynamic information, and the relationship with body area, so that the surgeons can understand the perforators more accurately and intuitively, and improve the success and efficiency of flap graft surgery.

Perineoscrotal reconstruction following fournier's gangrene using the upper medial thigh perforator flap

Background: Fournier's gangrene (FG) is a synergistic necrotizing fasciitis that involves the genitalia, perineum, or anal region and can be life threatening and generally necessitates urgent surgical intervention. It often causes scrotal defects that require reconstruction after surgical debridement. The reconstruction of these serious scrotal defects poses certain challenges for surgeons. In this study, reconstruction of scrotal defects caused by FG with medial circumflex femoral artery perforator (MCFAP) flap evaluated. Patients and Methods: Seventeen patients with FG reconstructed using a MCFAP flap, admitted to our hospital between February 2003 and March 2017, are included in this study. Reconstruction with MCFAP flap results, mean debridement number, comorbid diseases, and length of hospital stay are analyzed together. Patients with FG reconstructed using techniques other than MCFAP were not included in this study. Results: Eighteen MCFAP flaps were performed in 17 patients. The mean duration of operation was 2 h 55 min. Diabetes mellitus was the most common comorbid disease. The mean days of hospital stay were 19.9. Total flap loss was not seen in 17 patients. Donor area of the flap is closed primarily, by V-Y advancement flaps or by split-thickness skin grafts. Acceptable cosmetic results and scrotal contours were obtained in all patients. No major complications were observed. Conclusions: Using a MCFAP flap, a method that has minimal donor site morbidity, requires single session surgery, provides good skin quality and color similar to the scrotum, is an easy-to-perform process, proving to be a reliable flap for scrotal reconstruction.

Lambeau fasciocutané sous fessier fiabilisé par une perforante de l’artère fémorale profonde en reconstruction d’escarre ischiatique

The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers. A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily. A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory. Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size.

Effects of perforator flaps combined with muscle flaps for repairing grade Ⅳ pressure ulcers in ischial tuberosity of elderly patients

Objective: To explore effects of perforator flaps combined with muscle flaps for repairing grade Ⅳ pressure ulcers in ischial tuberosity of elderly patients. Methods: Nine elderly patients with grade Ⅳ pressure ulcers in ischial tuberosity were hospitalized in our burn ward from April 2014 to April 2017. Size of wounds ranged from 5 cm×3 cm to 12 cm×7 cm, and depth of sinus ranged from 6 to 22 cm. After admission, emergency debridement or debridement in selective time was performed. After debridement, the wounds were treated with continuous vacuum assisted closure therapy. After the treatment for 1 to 2 weeks, tissue flaps repair operations were performed. Four patients were repaired with inferior gluteal artery perforator flaps combined with long head of biceps femoris muscle flaps. Three patients were repaired with inferior gluteal artery perforator flaps combined with semimembranous muscle flaps. One patient was repaired with inferior gluteal artery perforator flap combined with gracilis muscle flap. One patient was repaired with femoral profound artery perforator flap combined with gluteus maximus muscle flap, and the distal area of femoral profound artery perforator flap of the patient which showed intraoperative cyanosis of 6 cm×4 cm was thinned to medium thickness skin to cover the muscle flap. The other eight patients showed no abnormality during operation. Size of perforator flaps ranged from 7 cm×5 cm to 14 cm×12 cm, and size of muscle flaps ranged from 11 cm×4 cm to 24 cm×6 cm. The donor sites of flaps were all sutured directly. Results: The tissue flaps and skin graft of all patients survived well after operation. During follow-up of 8 to 35 weeks, operative area of all patients showed good shape and texture, with no local diabrosis or recurrence of pressure ulcers. Conclusions: The combination of perforator flaps and muscle flaps is effective in repairing and reducing recurrence of grade Ⅳ pressure ulcers in ischial tuberosity of elderly patients.

The Superficial Femoral Artery Flap: A 3-Dimensional Anatomical Study.

The superficial femoral artery perforator (SFAP) flap offers advantages for pedicled transfer including consistent perforators and vascular territory, well-hidden donor site scar, and hairless flap skin. This article provides a historical overview of the SFAP flap and describes the vascular anatomy of the SFAP by 3-dimensional analysis and angiography. Ten fresh cadavers were injected using the lead oxide technique through the femoral artery. Spiral computed tomographic scanning and 3-dimensional evaluation were used to describe the SFAP number, diameter, length, type, and location. A total of 288 perforators in 15 cadaver limbs were identified; 19 ± 8 perforators per thigh ≥0.5 mm in diameter, with an average diameter of 0.8 ± 0.3 mm and a range of 0.5 to 2.1 mm; the mean length of each perforator was 68 ± 31 mm; 45% were septocutaneous and 55% were musculocutaneous. The medial thigh region was divided into 6 areas (anterior and posterior halves, then the proximal third, middle third, and distal third of each). The majority of the perforators were located in the middle and distal thirds of the anteromedial thigh (33% each). Using 3-dimensional vascular anatomical analysis, the number, location, length, type, and diameter of the SFAP were documented. In the literature, relatively few reports of the use of the SFAP flap are available, however, this is a valid donor site with consistent cutaneous perforators suitable for harvest as a local or regional flap transfer. This is the first 3-dimensional vascular anatomical study to comprehensively document the vascular anatomy of the SFAP flap.

A reliable parameter for primary closure of the donor site of the descending branch of the circumflex femoral lateral artery perforator flap and analysis its effective factors

Objective To explore a reliable parameter for primary closure of the donor site of the descending branch of the circumflex femoral lateral artery perforator flap and analysis its effective factors. Methods Between August, 2014 and December, 2015, 149 patients undergoing reconstructive procedures using the descending branch of the circumflex femoral lateral artery perforator flaps were included in the study. All patients were divided into two groups: primary closure of the donor site (135 cases) and none primary closure of the donor site (14 cases) . The receiver operating characteristic curve for biostatistical analysis was performed to identify the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap. The parameter, including the age, patients’ body mass index, subcutaneous fat thickness, thigh circumference and the maximum flap width, were recorded in 79 patients who were randomly choose from all patients. The method through stretching donor site skin was used to assess the maximum flap width. The maximum flap width-to-thigh circumference ratio was calculated. The Pearson test was used to analysis the correction between those parameters. Results Primary closure of the donor site was possible in 135 patients and impossible in 14 patients. The receiver operating characteristic curve for biostatistical analysis identifying the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap was 8.75㎝. The method assessed the reliable width of the flap was (8.37±1.67) cm through stretching donor site skin. the reliable width of the flap was (8.55±1.65) cm in the male patients and (7.42±1.5) cm in the female patients. Primary closure can be achieved if the flap width-to-thigh circumference ratio was less than (17.23±3.84) percent. There was a significant negative correlation between subcutaneous fat thickness and the ratio (R=-0.299, P < 0.05) and between body mass index and the ratio (R=-0.21, P < 0.05) . Conclusion The width of flap less than 8.75㎝ is a reliable parameter for primary closure of the descending branch of the circumflex femoral lateral artery perforator flap donor site. The patient’s body mass index and subcutaneous fat thickness of the thigh should be taken into consideration. Key words: Perforator flap; Circumflex femoral lateral artery; Donor site morbidities

The proximal superficial femoral artery perforator flap: Anatomic study and clinical cases.

The upper thigh has provided multiple new soft tissue free flaps in recent decades, including the anterolateral thigh, anteromedial thigh, transverse upper gracilis, the profunda artery perforator, and superficial circumflex iliac perforator flaps. The purpose of this study is to describe a new, reliable free flap option in the upper thigh: the proximal superficial femoral artery perforator (p-SFAP) flap. A cadaveric dissection study was performed to confirm clinical landmarks and evaluate pedicle characteristics. A retrospective review of patients who have received a p-SFAP free flap and surgical technique are described in detail. Eight patients (aged 27-85 years) underwent reconstruction with the p-SFAP flap involving six upper and two lower extremity defects. A consistent pedicle 6 to 8 cm in length was identified in all cadaveric and clinical limbs, emerging from under the lateral aspect of the sartorius muscle and entering the flap approximately 10 cm inferior and 4 cm medial to the anterior superior iliac spine. The perforator took origin off of the superficial femoral artery and femoral vein in all clinical cases. Arterial and venous diameters were 1.2-1.5 mm and 2.0-2.5 mm, respectively. There was one occurrence of partial flap necrosis and one case of complete flap loss. The p-SFAP flap represents a new, clinically relevant addition to the armamentarium of the reconstructive microsurgeon for use in small to medium sized defects. It can be harvested as a free flap and may have utility as a pedicled flap for groin and perineal reconstruction.

Erratum to: Breast reconstruction using free medial circumflex femoral artery perforator flaps: intraoperative anatomic study and clinical results.

A free fascioadipocutaneous flap obtained from the medial thigh is suitable for breast reconstruction in Asian women with a small-to-moderate breast size. In this region, both a medial circumflex femoral artery perforator flap (MCFAp flap) and a posterior medial thigh perforator flap (PMTp flap) are options, based on perforators from the deep femoral vessels. Here, we evaluated the anatomic basis of the medial circumflex femoral artery (MCFA) perforators from the medial circumflex femoral vessels. Between July 2010 and June 2014, 53 patients (55 flaps) underwent breast reconstruction using a fascioadipocutaneous flap from the medial thigh. MCFA perforators larger than or equal to 0.5 mm in this region were investigated. The following parameters were recorded intraoperatively: number of perforators, perforator locations, distance of the perforating point from the proximal thigh crease and anterior border of the gracilis muscle. The total number of perforators was 131, with a mean of 2.4. The number of perforators coursing through the gracilis muscle (gracilis perforators) was the largest, followed by septocutaneous perforator coursing between the adductor longus and gracilis muscle. The average perforating point was located 6.5 cm below the proximal thigh crease and 2.2 cm from the anterior border of the gracilis muscle. Of the 102 procedures performed since 2006, 15 flaps were elevated as MCFAp flaps and there was no major complication. In some cases, MCFA perforators are dominant in this region compared to PMT perforators. A perforator map can be helpful for identifying adequate MCFA perforators intraoperatively.

Breast reconstruction using free medial circumflex artery perforator flaps: intraoperative anatomic study and clinical results

A free fascioadipocutaneous flap obtained from the medial thigh is suitable for breast reconstruction in Asian women with a small-to-moderate breast size. In this region, both a medial circumflex femoral artery perforator flap (MCFAp flap) and a posterior medial thigh perforator flap (PMTp flap) are options, based on perforators from the deep femoral vessels. Here, we evaluated the anatomic basis of the medial circumflex femoral artery (MCFA) perforators from the medial circumflex femoral vessels. Between July 2010 and June 2014, 53 patients (55 flaps) underwent breast reconstruction using a fascioadipocutaneous flap from the medial thigh. MCFA perforators larger than or equal to 0.5mm in this region were investigated. The following parameters were recorded intraoperatively: number of perforators, perforator locations, distance of the perforating point from the proximal thigh crease and anterior border of the gracilis muscle. The total number of perforators was 131, with a mean of 2.4. The number of perforators coursing through the gracilis muscle (gracilis perforators) was the largest, followed by septocutaneous perforator coursing between the adductor longus and gracilis muscle. The average perforating point was located 6.5cm below the proximal thigh crease and 2.2cm from the anterior border of the gracilis muscle. Of the 102 procedures performed since 2006, 15 flaps were elevated as MCFAp flaps and there was no major complication. In some cases, MCFA perforators are dominant in this region compared to PMT perforators. A perforator map can be helpful for identifying adequate MCFA perforators intraoperatively.

Reliable transfer of multiple perforator-based pedicled flaps: Surgical technique and clinical outcomes.

Although an increase in flap perfusion by incorporating multiple perforators has been demonstrated with free perforator flaps, whether the same efficacy can be achieved with pedicled flaps remains unclear, due to concerns regarding pedicle tension or kinking during flap transposition. The aim of this report was to investigate the reliability of multiple perforator-based pedicled flaps in a series of clinical cases. Twenty-six patients undergoing soft tissue reconstruction using multiple perforator-based pedicled flaps from 2008 to 2012 were reviewed. The causes of the defects were oncologic (n = 15) or chronic wounds (n = 11). The defect sites were the trunk (n = 19), lower extremities (n = 4), head and neck (n = 2), and upper extremities (n = 1). Diverse flap types were used, including the superior gluteal artery perforator flap, the lateral femoral circumflex artery perforator flap, the medial femoral circumflex artery perforator flap, and the thoracodorsal artery perforator flap. The flaps were transposed in a rotation-and-advancement manner after skeletonizing each perforator and proximally dissecting the pedicle. The donor site was closed primarily. Mean flap size was 125.2 cm2 , and the mean number of perforators used was 2.3 (2-5). The mean angle of pivotal rotation for flap transposition was 132.8°. No rotation-related problems including pedicle kinking or twisting developed, and all flaps survived completely. No significant donor-site morbidity was observed. The mean follow-up period was 38.1 months. This report suggests that through meticulous dissection of pedicles of sufficient length, the multiple perforator-based pedicled flaps can be successfully transposed while minimizing the risk of pedicle tethering. © 2015 Wiley Periodicals, Inc. Microsurgery 37:105-111, 2017.

Pedicle perforator flaps for vulvar reconstruction — New generation of less invasive vulvar reconstruction with favorable results

ObjectivesVulvar reconstruction after cancer surgery remains challenging. Pedicle perforator flaps are believed to be a less invasive option with better cosmesis. MethodsA retrospective review identified 27 flaps in 16 patients who underwent vulvar reconstruction after cancer surgery using island pedicled perforator flaps. Their average age was 55.7±17.8years (Range: 22–85). The average BMI was 23.5±4.0 (range: 18.8–28.5). Five of the 16 patients underwent unilateral vulvar reconstruction, and 11 of them underwent bilateral vulvar–perineal reconstructions. The perforator flaps included deep femoral (profunda) artery perforator (DFAP or PAP) flaps (n=11), medial circumflex femoral perforator (MCFAP) flaps (n=8), external pudendal artery perforator (EPAP) flaps (n=2), medial thigh free style perforator flaps (n=2), and internal pudendal artery perforator flaps (n=4). ResultsAll flaps survived with a 100% success rate. Three patients developed small wounds that required debridement and closure after the reconstruction. All donor sites were closed primarily. One patient developed temporary peroneal nerve palsy.During follow-up, none of the patients presented with donor site morbidities. All of the patients were satisfied with the cosmetic and functional results, except that one patient underwent a flap debulking procedure three months after surgery. ConclusionsCompared to traditional myocutaneous flaps, perforator flaps provide thinner fasciocutaneous flaps for vulvar reconstruction with favorable reconstruction results and fewer donor site morbidities. The medial or inner thigh is a region that is rich in perforators, which allow for more versatile flap design according to the defect. Furthermore, most of the donor site can be closed primarily without complications.

Successful lower extremity salvage with free flap after endovascular angioplasty in peripheral arterial occlusive disease

Most patients with peripheral arterial occlusive disease undergo lower limb amputation due to complex wounds on their lower extremities. We have taken the challenging approach of combining angioplasty and free tissue transfer for limb salvage. Between October 2011 and December 2013, 11 patients (average age of 56.8 years; ranged from 43-72 years old) with peripheral arterial occlusive disease of main tibioperoneal arteries underwent preoperative angioplasty. Afterward, free tissue transfers (nine anterolateral thigh free flaps, one vastus lateralis muscle free flap, and one deep femoral artery perforator flap) were performed on these patients for lower extremity salvage and reconstruction. All 11 free tissue transfers after angioplasty were successful without operative mortality or major complications. Minimal wound dehiscence was seen in one case, and partial flap necrosis was seen in the other cases. During the follow-up period, all of the patients had their wounds healed completely and achieved acceptable contour and quality of gait. The preoperative angioplasty provides well-vascularized tissue that both controls infection and helps free flaps to survive. Therefore, the patients due to receive leg amputation in spite of the free tissue transfer can achieve limb salvage by using the additional technique of angioplasty. This combined approach was successful in preserving the functional aspects along with the aesthetic results for the lower limb reconstruction.

Superficial Femoral Artery Perforator Flap

The medial thigh has been infrequently studied as a donor site for pedicled or free flaps. In their previous studies, the authors observed a direct cutaneous branch from the superficial femoral artery. This study aimed to investigate the anatomy and potential possibility for flap elevation (the midmedial thigh flap) on this direct branch of the superficial femoral vessels. Circumferential adipocutaneous thigh flaps were harvested from 14 fresh adult cadaver legs. The direct cutaneous branch from the superficial femoral vessels was located between the sartorius and gracilis muscles. Pedicle location, diameter, and length and position of the great saphenous vein and saphenous nerve were recorded. A flap based on this vessel was designed. Height, width, and surface of the skin paddle were recorded. Three-dimensional computed tomographic angiography was used to analyze the area of cutaneous territory supplied by the studied perforator. The pedicle was located at an average distance of 22.79 ± 1.55 cm below the pubic tubercle on the medial axis of the thigh, and it was found in 100 percent of dissections. It was always located between the sartorius and gracilis muscles, with a mean diameter of 2.82 ± 0.69 mm and mean length of 4.79 ± 0.52 cm. The average area of skin perfused was 182.24 cm, located preferentially distal and posterior to the perforator pedicle. Two clinical cases illustrate the feasibility of the midmedial thigh perforator flap. The superficial femoral artery perforator flap appears to be reliable and has a constant vascular anatomy. Donor-site morbidity is low, resulting in only a vertical scar on the medial thigh. Therapeutic, V.

An Alternative Method for Facial Resurfacing

Prefabrication of supraclavicular skin provides a useful source for flaps congruent with the face skin. Among various vascular sources that have been used for this purpose, anterolateral thigh fascia seems to represent a greater value because of having a long and strong vascular pedicle and negligible donor-site morbidity. In this regard, we present a technical report on using the lateral circumflex femoral artery perforator flap harvest technique in preparing an anterolateral thigh fascia flap for the prefabrication of the supraclavicular skin. The technique proved successful in resurfacing the facial skin of a young female patient with a giant congenital melanocytic hairy nevus on the left side of her face.

Pedicled superficial femoral artery perforator flaps for reconstruction of large groin defects

Soft-tissue defects after wide resection of groin sarcomas have been reconstructed with well-characterized flaps, such as rectus abdominis, gracilis, and anterolateral thigh flaps. To our knowledge, the use of superficial femoral artery perforator (S-FAP) flaps for this purpose has not been reported. We report on three female patients in whom groin defects after sarcoma resection were reconstructed with pedicled S-FAP flaps. The dimensions of the skin defects ranged from 13.5 × 11 to 16 × 14.5 cm. Sizable perforators from the superficial femoral arteries were identified preoperatively around the apex of the femoral triangle with computed tomographic angiography or color Doppler ultrasonography. The lengths of the flaps ranged from 17 to 19 cm. The main perforator penetrated the sartorius muscle in two patients and emerged between the sartorius and the adductor longus muscles in the other patient. The postoperative course was uneventful, and results were satisfactory in all patients. The main advantages of the S-FAP flap over more commonly used flaps are that it is easier to harvest and is associated with less donor-site morbidity. We believe that the S-FAP flap may be a versatile option for the coverage of groin defects.