Femoral Artery Perforator Flap Research Articles

Immediate reconstruction using free medial circumflex femoral artery perforator flaps after breast-conserving surgery

Recent advances in perforator flap surgical techniques have allowed for safe and reliable autologous tissue transfer with minimal donor-site morbidity. Between April 2012 and January 2013, we performed immediate breast reconstruction using free medial circumflex femoral artery perforator (MCFAP) flaps in 15 patients after breast-conserving surgery. The flaps were harvested from patients in the lithotomy position, while a second surgical team simultaneously conducted tumour resection. Of the 15 procedures performed, three flaps were dissected as true perforator flaps, while 12 flaps were dissected as muscle-sparing perforator flaps. The mean flap weight was 138.5 g (range, 77-230 g) and the mean pedicle length was 5.7 cm (range, 3.0-9.0 cm). Recipient vessels for anastomosis were serratus branches in 10 patients, internal mammary vessels in three patients and thoracodorsal vessels in two patients. The mean duration of surgery was 6.74 h (range, 5.65-9.45 h). There were no major complications requiring surgical intervention. Researchers observed partial flap necrosis, which manifested as small firm lesions in two patients, as well as local wound infection and dehiscence in one patient, which resolved spontaneously. There were no instances of donor-site seroma formation or lymphoedema in any of the patients. An objective assessment of postoperative photographs showed that cosmetic results were mostly satisfactory. Donor-site scars along the medial groin crease were inconspicuous and readily concealed by clothing. Given its reliable vascularity and minimal donor-site morbidity, the free MCFAP flap can be a good alternative for partial breast reconstruction after breast-conserving surgery.

Free pre-expanded lateral circumflex femoral artery perforator flap for extensive resurfacing and reconstruction of the hand

Resurfacing and reconstruction of extensive scars, severe contractures and deformities of the hand are still challenging cases for plastic surgeons. Treatments usually necessitate thin, pliable and broad flaps. Additionally, minimising the donor-site morbidity is an indisputable requisite. The pre-expanded perforator flap technique has been shown to provide extensive, thin and pliable skin with increased vascularity while reducing the donor-site morbidity. Utilisation of free pre-expanded lateral circumflex femoral artery perforator flap in an aesthetic and functional reconstruction of severe post-burn hand deformity is demonstrated. The successful functional and aesthetic outcome that was achieved in the early postoperative period and which still persists after 23 months of follow-up indicates that our technique could be preferably used in the extensive coverage of the hand.

Application of lateral femoral circumflex artery perforator flaps and fit together for limbs complex wound surface

Objective To evaluate the feasibility and clinical efficacy of lateral femoral circumflex artery perforator flaps and fit together in the treatment of limbs complex wound surface.Methods From January 2010 to March 2012,use the characteristics that the descending branch of lateral femoral circumflex artery extend its branches over the flap,fascia and skin,to form lenticulostriate arteries,which contain 2 to 3 different species tissues fits together,flaps cover the important tissues such as vessel,nerves and bones.Fascia covers the tendinous tissues etc.Muscle can not only cover the tissues,but also fill in the space,and followed by skin grafting.This research was to perform the treatment for 4 cases of lacking limbs ring tissue,three cases of multiple wound surface,six cases of hand avulsion injury of skin and 9 cases of Gustilo grade-Ⅲ C.Results As for the 22 cases in the research,nineteen cases of flaps survived,the other 3 cases were necrosis with length of 1cm to 2 cm at distal and self-healed later.During 6 months to 2 years followed-up of 18 cases,external flaps were satisfactory,skin grafting over the fascia layers develops very well,smooth with great elasticity,no recoil,and no color change.Conclusion Lateral femoral circumflex artery is one of effective restoration methods for limbs with complex wound surface. Key words: Lateral femoral circumflex artery; Perforator flaps; Chimeric perforator flap; Transplantation; Microsurgical operation

Islanded Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects

Hidradenitis suppurativa is a recurrent, chronic, and suppurative cutaneous disease of unknown etiology. Radical excision of all affected skin followed by flap coverage of the defect is the treatment method of choice in severe and recurrent cases. This study discusses the use of local islanded perforator flaps in the reconstruction of defects following excision of hidradenitis suppurativa lesions in axillary, gluteal, and inguinal regions. Eleven male patients (mean age of 39.3 years) underwent reconstruction of hidradenitis suppurativa defects with 13 local islanded perforator flaps. Three patients (one being bilateral) had gluteal, two patients (one being bilateral) had inguinal, and six patients had axillary involvement. The defects in the gluteal region were repaired with superior gluteal artery perforator flaps, inguinal defects were repaired with medial circumflex femoral artery perforator flaps, and the axillary defects were repaired with thoracodorsal artery perforator flaps. There was no total flap loss in the postoperative period, but one marginal necrosis and two wound infections occurred. There was no recurrence of hidradenitis suppurativa or revision requirement during the mean follow-up period of 11.5 months.

Breast Reconstruction Using the Lateral Femoral Circumflex Artery Perforator Flap

Breast Reconstruction Using the Lateral Femoral Circumflex Artery Perforator Flap

Deep Femoral Artery Perforator Flap: A New Perforator Flap for Breast Reconstruction

Deep Femoral Artery Perforator Flap: A New Perforator Flap for Breast Reconstruction

Microsurgical Reconstruction In Pediatric Patients: A Series Of 30 Patients

Free flap surgery in the pediatric population has gained widespread acceptance regarding its technical utility and reliability. Initial concerns as to the feasibility and reliability of the procedure in children were resolved over time. Thirty children (15 boys, 15 girls) were treated in Sisli Etfal Training and Research Hospital, Plastic and Reconstructive Surgery Clinic. Their mean age was 10.8 years. Defects were located on the lower extremity (n=22), head and neck (n=5) and upper extremity (n=3). The etiologies of the defects included vehicle accident, sequelae of burn, traumatic contractures, crush injury, epulis in the maxilla, and gunshot wound. The free flaps performed in our series were latissimus dorsi muscle flap, combined latissimus dorsi and serratus muscle flaps, serratus anterior muscle flap, cross latissimus dorsi muscle flap, scapular osteomyocutaneous flap, parascapular fasciocutaneous flap, fibular osteocutaneous flap, anterolateral thigh flap, medial circumflex femoral artery perforator flap, and crista iliaca osteocutaneous flap. The advantages of free flaps in children, which include better adaptation of the flap growth and better learning capacity of the children, provide the surgeon with more satisfactory functional and aesthetic results.

Improving the Accuracy of Easily Accessible 5-MHz Handheld Doppler Examination in Perforator Flap Planning

Sir:FigurePreoperative handheld Doppler examination has been applied widely in planning perforator flap surgery because of its moderate cost, noninvasive nature, and simplicity.1 Ideally, an 8- or 10-MHz handheld Doppler probe is suitable for this purpose.2 The 5-MHz handheld Doppler probe is a more easily accessible choice because it can be found in several departments of every hospital; however, it has a higher tissue penetration depth. It is a fact that a 5-MHz handheld Doppler probe does not distinguish perforating vessels from main axial vessels and can create false-positive localization of perforators when the axial vessels run very superficially.3 In the pediatric population and slim adults, the source arteries lie too close to the skin. The purpose of our study was to demonstrate a practical way of using 5-MHz handheld Doppler examination in perforator flap planning in children, in thin adults, and in extremities. Institutional review board approval was obtained before our examination procedures began. Lateral circumflex femoral artery perforator flap planning was performed on either of the thighs of six pediatric volunteers. The mean age of the patients was 11 years (range, 8 to 14 years) and all were in the healthy range in terms of body mass index. Vessel signals were sought using a handheld Doppler device (Huntleigh Multi Dopplex MD 1; Huntleigh Health Care Ltd., Cardiff, United Kingdom) with a 5-MHz probe. In all volunteers, the signals of the perforators and the source artery were mixed up, all over the course of the descending branch of the lateral circumflex femoral artery. (See Video, Supplemental Digital Content 1, which demonstrates the clutter of signals, https://links.lww.com/PRS/A640.) As the proposed supplementary procedure, an inflatable toy balloon filled with water is used as a distance protector between the skin and the handheld Doppler probe. Ultrasound gel is applied both on the skin-balloon interface and on the balloon-probe interface. At the beginning, to detect a clear signal, the probe is pushed through the balloon toward the marked point of possible perforator sites, close to the vessels (Fig. 1, above). After acquisition of the signal, the probe is moved away from the skin slowly, maintaining the contact with the balloon until the signal becomes significantly weakened and hardly heard (Fig. 1, below). At that height, if no signals are detected around this premarked possible point of perforator, that point is regarded as a probable perforator site. (See Video, Supplemental Digital Content 2, which briefly demonstrates the barely heard signals isolated on a premarked possible point of perforator, https://links.lww.com/PRS/A641.)Fig. 1: (Above) The probe is embedded in the water-filled toy balloon and directed toward one of the premarked possible perforator positive points. This way, it is approximated to the skin to find the vessel signals more easily. (Below) The probe is elevated until the sound becomes significantly weakened, and this final distance is protected.Video 1: Supplemental Digital Content 1 demonstrates the clutter of signals, https://links.lww.com/PRS/A640.Video 2: Supplemental Digital Content 2 briefly demonstrates the barely heard signals isolated on a premarked possible point of perforator, https://links.lww.com/PRS/A641.In all six volunteers, the technique worked properly and probable perforator signals could be differentiated from the underlying source artery signals. In two of these volunteers, a radiologist checked probable perforator sites by color Doppler ultrasound imaging, and these points were found to include subcutaneous perforator vessels. The balloon verification increases the specificity and preserves the sensitivity and thus increases the overall accuracy of the 5-MHz handheld Doppler examination. Thus, it seems to be feasible for a perforator flap surgeon, who is in a period of abstinence from technology (as occurs sometimes in appointments to peripheral hospitals), to use a borrowed 5-MHz handheld Doppler device with simple balloon verification in preoperative planning. It may also be useful in verification of the perforator points detected by an 8-MHz handheld Doppler device. Emre Hocaoğlu, M.D. Hüseyin Elbey, M.D. Department of Plastic Reconstructive and Aesthetic Surgery Artur Salmaslıoğlu, M.D. Department of Radiodiagnostics Metin Erer, M.D. Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey The preliminary work of this study was presented as an oral presentation at the Fifth National Congress of the Turkish Society of Reconstructive Microsurgeons, in Bodrum, Turkey, December 15 through 17, 2011. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Superiority of Medial Circumflex Femoral Artery Perforator Flap in Scrotal Reconstruction

Scrotal skin has unique cosmetic and functional features that make its reconstruction difficult. Coverage of the testicles and constituting a good cosmetic appearance are major expectations from a successful reconstruction. Usually flaps are the choice for scrotal reconstruction, but every single flap has its own characteristics. In our series, between January 2006 and January 2010, the medial circumflex femoral artery perforator flap was used in 7 male patients for scrotal coverage after Fournier gangrene. Six flaps were raised based on a single perforator from the gracilis muscle; however in one flap 2 perforators were used. Flaps were carried to the defect either by transposition or by V-Y advancement. Donor areas were closed directly in all patients, and stable scrotal coverage was achieved with an acceptable scrotal contour and cosmesis. No major complication was seen due the perforator flap surgery, in 2 patients wound dehiscence were noted and they healed by secondary intention or by secondary suturing. For scrotal reconstruction, the medial circumflex femoral artery perforator flap is a good option with its good mobility, thinness for scrotal contour, possibility for muscle preservation, and direct closure of the donor site. All these advantages can be accomplished in 1 procedure.

Deep Femoral Artery Perforator Flap: A New Perforator Flap for Breast Reconstruction

We present the deep femoral artery perforator (DFAP) flap, a new perforator flap for breast reconstruction, with a detailed description of operative technique and four clinical examples. The DFAP flap allows harvest of tissue from the lower buttock and lateral thigh with similar territory to an in-the-crease inferior gluteal artery perforator (IGAP) flap but based on a different perforator. When present, the DFAP is the largest vessel supplying this territory and is often septocutaneous, facilitating dissection when compared with the IGAP flap. We used preoperative imaging with magnetic resonance angiography to assist in accurate flap planning which also permitted precise determination of perforator origin. In patients with either a contraindication to abdominal wall-based perforator flaps or weight distribution below the waist, the DFAP flap provides an alternative to the IGAP flap with an excellent pedicle and a favorable location on the lateral thigh.

Breast Reconstruction Using the Lateral Femoral Circumflex Artery Perforator Flap

The development of microsurgical breast reconstruction has resulted in not only the lower abdomen as a source of donor site tissue but also interest in alternative donor sites. These have included perforator-based flaps at the sites of previously described myocutaneous flaps (e.g., superior or inferior gluteal arteries) and the use of myocutaneous flaps not previously used for breast reconstruction (e.g., gracilis or transverse upper gracilis). We present our experience with a unique form of the tensor fascia lata flap and describe the first reported use of the lateral femoral circumflex artery (LFCA) perforator flap for breast reconstruction. A patient with minimal abdominal fat but lipodystrophy of the upper lateral thighs presented for breast reconstruction. Perforator flaps based on the lateral femoral circumflex vessels were designed. The LFCA perforator flap from one side was successfully used for breast reconstruction. The flap on the contralateral side did not have a suitable perforator. The LFCA perforator flap offers another option for women seeking autogenous breast reconstruction. Advances in preoperative imaging will likely make this a more reliable option.

Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap

Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects.

Medial Circumflex Femoral Artery Perforator Flap in a Seven-Year-Old Boy for a Degloving Ankle Injury: A case report in immediate reconstruction

Degloving injuries and high-energy trauma of distal lower extremity is fortunately rare in children and there are a limited number of articles that have been written about microsurgical management of these injuries. In the pediatric population, it was realized that free flaps could be safely used in the treatment of soft-tissue defects. First, critical issues as to the feasibility and reliability of the intervention in children were rapidly overcome as it was realized that the relative size of the pedicle vessels is larger in children than that in adults. The same holds true for the perforator vessels; although they can be relatively small in children, their relative size compared with the size of the child’s body is greater than that in adults. In this case report, a 7 year-old boy sustained a severe mangling, crushing type injury of his right ankle in an elevator-door related accident. He sustained a degloving injury of the anterolateral aspect of the ankle, an ipsilateral tarsal fracture and ankle subluxation. We have confirmed the versatility and safety of the medial circumflex femoral artery perforator flap in this type of injury within the first 24-hours after the injury. Without undermining, the donor site was closed directly in an almost linear scaring the gluteal fold that can be easily concealed. We found the medial circumflex femoral artery perforator flap is one of safe and suitable flap choice in children who have a defect on the distal one third of tibia in the acute period of trauma.

Use of the Lateral Circumflex Femoral Artery Perforator Flap in the Reconstruction of Gunshot Wounds to the Face

The reconstruction of large avulsive tissue loss in the head and neck region is one of the most difficult tasks faced by reconstructive surgeons. The advent of free tissue transfer has improved our ability to predictably reconstruct these patients. One of the most recent advances in the field of microvascular surgery is the use of perforator flaps. We have used the lateral circumflex femoral artery perforator (LCFAP) flap for reconstructions in patients who have suffered severe gunshot wounds (GSWs) to the maxillofacial area. A retrospective chart review was conducted of patients treated with a LCFAP flap in our division for large defects of the face resulting from GSWs between July 2005 and July 2006. The patient's age and gender, site and size of defect, and degree of bone and soft tissue loss were recorded. Flap survival and donor site morbidity were noted as outcomes of the reconstruction. Four patients who met the inclusion criteria were identified. The success rate for the flaps was 100%. There was no partial necrosis of the flaps. The size of the defect ranged from 20 x 10 cm to 10 x 10 cm. None of the patients had donor site complications, and all donor sites were closed primarily. Use of the LCFAP flap for the reconstruction of large defects secondary to GSWs to the face is a reliable option for the immediate reconstruction of this patient population. The lateral circumflex femoral artery perforator (LCFAP) flap is at a site not involved in the immediate resuscitation of trauma patients, thus ensuring an intact vascular system. This fact makes the LCFAP flap a reliable source for small to large soft tissues for reconstructing avulsive soft tissue losses in the head and neck.

Scrotal Reconstruction Following Fournier Gangrene Using the Medial Circumflex Femoral Artery Perforator Flap

Fournier gangrene can have devastating consequences. Often in the male, the testicles become exposed and demand both a functional and esthetic coverage. Local medial thigh cutaneous flaps usually still are available and have evolved to become a preferred solution. The medial circumflex femoral artery perforator (MCFAP) flap based on musculocutaneous perforators of the gracilis muscle represents yet another one of these options. As with all muscle perforator flaps, no muscle need be expended. A case report illustrates the role of the MCFAP flap for creation of a neoscrotum.

The Development of the Medial Circumflex Femoral Artery Perforator (MCFAP) Flap

In the quixotic quest for the “ideal” flap, the major attribute of the medial circumflex femoral artery perforator flap is its minimal donor-site deformity even if primary closure is not possible and a skin graft must be used. This source vessel captures the medial groin skin territory, and therefore sometimes has been referred to as the “medial groin” flap. This flap can be moderately large, the donor site easily hidden by clothing, the flap almost always has at least a single relatively large musculocutaneous perforator, and the location of the vascular pedicle has a consistent location already familiar to most microsurgeons. The history and approach specifically in the development of the medial circumflex femoral artery perforator flap is presented here to explain the rationale as to why this donor site deserves consideration in the hierarchy of cutaneous flap selection.