Lateral Circumflex Femoral Artery Perforator 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.

Anatomic features of the oblique branch of lateral circumflex femoral artery and its clinical significance

Objective This study revisits the blood supply of the oblique branches in the light of recent advances in the understanding of the vascular anatomy of the anterolateral thigh, and observes its clinical application effect. Methods From January, 2014 to January, 2016, a prospective intraoperative observational study was performed in 57 consecutive anterolateral thigh flaps, noting the dimensions and locations of the oblique and descending branches and the number and size of the muscle branches supplying the rectus femoris. Twenty-one patients were found with the oblique and descending branches and performed the free flap pedicled with collateral branch of oblique rarus of lateral circumflex femoral artery to fix the foot and ankle in 12 cases. There were 8 males and 4 females with an age range from 23 to 52 years. They were injuried by traffic accident (6 cases), by object hit from height (4 cases),or hurted by machines (2 cases). The locations were foot in 5 cases, ankle in 4 cases, and at the distal shank in 3 cases. The disease duration was 4 hours to 36 hours (mean, 16 hours). Six skin flaps, 4 fascia flap plus skin flap, 2 ramified flaps harvest were then completed as planned. The size of flaps ranged from 7 cm × 11 cm to 8 cm × 21 cm, and the donor sites were closed directly in all cases. Results On the basis of the dimensions and locations of the oblique and descending branches supplying the rectus femoris, all cases were devided into type I (descending branche, 16 cases), type II(the oblique and descending branche, 2 cases), type III(oblique branche, 3 cases). After operation, all the flaps survived, while wound dehiscence accured in 1 case and healed after dressing change and left a slash residual scar without pulling discomfort. The donor site was accompanied by a decrease in the range of peripheral sensory numbness. Early muscle strength of hip and knee arised in 3 cases, got better in 3 months and dispeared in 6 months. By way of telephone follow-up, 12 patients were followed for 3-24 months (mean, 13 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking. Conclusion Blood vessels should be carefully identified, while flaps are harvested with diversity of blood supply. As it is improved that the oblique branch of lateral circumflex femoral artery perforator tissue flap is simple and reliable, also can perform various forms of perforator flaps. Key words: Oblique branch, lateral circumflex femoral artery; Perforator flap; Applied anatomy; Repair

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.

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.

Detection on distribution and flowing dynamics of the vessel perforators by use of high frequency color ultrasound and contrast-enhanced ultrasound

Objective To study the distribution and flowing dynamics of perforator vessel of perforator flap detected by high frequency color ultrasound and contrast-enhaned ultrasound (CEUS) in order to provide reasonable evidence for the design of location and protocol of skin flap.Methods From December 2011 to July 2012,forty-nine patients with soft tissue defects were studied by CEUS and 3D ultrasound.In addition to the position where the blood vessel perforates from muscle into adipose layer,the research emphasized to display the relationship of perforator and its source vessel,detect the number of perforator vessel vascular initial diameter,distribution,and flowing dynamics in the donor site.The straighter and bigger perforators were the first choices.The infection and hardening of the arteries were detected in the accepting-site.Results Among them,forty-three subjucts were observed more clearly with CEUS than conventional ultrasound,totally 117 perforators were found in 49 donr sites.Perforators which were detected by ultrasound were confirmed in the surgery except 30 perforators of the fourth lumbar arteries.The transferred flaps survived completely.Conclusion Perforators can be displayed more clearly and located more accurately by CEUS,which plays a very important role in perforator flap.Three dimentional ultrasound can display excellent images with the information of perforators for clinical surgery. Key words: Contrast-enhanced ultrasound; Perforator flap; Deep inferior epigastric artery perforator; Arteria thoraco-dorsalis artery perforator; Lateral femoral circumflex artery perforator; Peroneal artery perforator; Posterior tibial artery perforator

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

Breast Reconstruction Using the Lateral Femoral Circumflex Artery Perforator Flap

Breast Reconstruction Using the Lateral Femoral Circumflex Artery Perforator Flap

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.

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.

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.