Lateral Femoral Artery Research Articles

Clinical effects of individualized free anterolateral thigh flap in repairing complex refractory wound

Objective: To explore the clinical effects of individualized free anterolateral thigh flap in repairing complex refractory wound. Methods: From July 2015 to May 2019, 19 patients with complex refractory wounds were hospitalized in Yulin NO.1 People's Hospital of Guangxi Zhuang Autonomous Region, including 12 males and 7 female, aged 13-67 years. There were 5 patients with multiple tissue defects, 7 patients with large area of wounds, and 7 patients with wounds in special areas. The sizes of wounds after complete debridement were 8 cm×5 cm-23 cm×7 cm. According to the repair demand, the wounds in 5 patients were repaired with anterolateral thigh flaps and flow-through, the wounds in 7 patients were repaired with anterolateral thigh flaps chimed with lateral thigh muscle flaps, with vascular anastomosis in 2 patients, the wounds in 6 patients were repaired with unilateral anterolateral thigh lobulated flaps, and the wound in 1 patient was repaired with bilateral anterolateral thigh flap in series connection. The sizes of flaps were 10 cm×7 cm-25 cm×9 cm. The donor sites were sutured directly or repaired with thin split-thickness skin graft of head. The survival of the flaps, the appearance of the donor sites, and wounds repair after the operation and during follow-up were observed. Results: The lobulated flap in 1 patient had local necrosis after the operation and finally healed by debridement, dressing change, and transplanting medium split-thickness skin graft in groin. The flaps in 18 patients survived with good blood supply, and the lobulated flap tissue was swollen in 1 of 18 patients. The donor sites which were directly sutured in 18 patients only had linear scar, and the donor site which was repaired with thin split-thickness skin graft of head in 1 patient had flaky scar. Follow-up of 1-12 months showed that all the wounds healed well, the flap thinning operations were performed in 5 patients in 3 months post operation because the flaps were slightly bloated. The CT angiography after the operation showed that the anastomosed blood vessels were unobstructed in 7 patients with reconstructed local blood supply. Conclusions: The special forms of anterolateral thigh flap, such as lobulation, series connection, and chimerism can be designed according to the anatomical characteristics of the descending branch of the lateral femoral artery to meet individualized repair demand for complex refractory wounds, and achieve the double purposes of making full use of the donor site tissue and good repair of the recipient site.

Effects of anterolateral thigh free flap with fascia lata in repairing dura mater defect after resection of head squamous cell carcinoma

Objective: To evaluate the clinical effects of anterolateral thigh free flap with fascia lata in the repair of dura mater defect after resection of head squamous cell carcinoma. Methods: From June 2016 to June 2018, Xijing Hospital of Air Force Medical University applied the free transplantation of anterolateral thigh flap with fascia lata to repair the dura mater defect of 12 patients with head squamous cell carcinoma, including 9 males and 3 females, aged from 35 to 74 years. The size of scalp soft tissue defects in patients after carcinoma resection ranged from 12 cm×10 cm to 24 cm×21 cm, and the size of dura mater defect of patients ranged from 7 cm×6 cm to 16 cm×14 cm. The size of flap of patients ranged from 14 cm×12 cm to 27 cm×24 cm, and the size of fascia lata ranged from 8 cm×7 cm to 17 cm×15 cm. The superficial temporal artery and middle temporal vein were connected by end to end anastomosis with the first musculocutaneous perforating branch of the descending branch of lateral femoral artery and its accompanying vein. The flap donor area was transplanted with autologous split-thickness skin graft from trunk and fixed with packing. Postoperative survival of flaps and skin grafts was observed. The patients were followed up regularly. The cranial magnetic resonance imaging was performed to observe the recurrence of intracranial tumors and dural integrity, shape of the flap and whether the donor site region was left with significant dysfunction were observed. Results: All the flaps and skin grafts survived well in 12 patients after surgery. Ten patients had primary healing at the edge of the flap suture; 2 patients had local sinus tract formation at the suture site of flap, with a small amount of cerebrospinal fluid leakage, and were recovered after outpatient dressing change. The patients were followed up for 10 to 36 months, and 3 patients with tumors involving in the dura mater sagittal sinus region had postoperative intracranial tumor recurrence. The tumor was resected again. All the patients had good dural integrity. The flaps of all patients were in good shape, and no obvious dysfunction remained in the flap donor site. Conclusions: Free transplantation of anterolateral thigh flap with fascia lata is an effective and reliable method to repair the dura mater defect following head squamous cell carcinoma resection. It can repair the scalp and dura mater defects caused by the invasion of squamous cell carcinoma and provide possibilities for skull reconstruction.

Alternative iliofemoral revascularization in extensive aortoiliac occlusive disease.

Over recent decades, there has been a considerable increase in use of endovascular methods to treat aortoiliac occlusive disease. It has been demonstrated that this approach offers many benefits, primarily for non-complex arterial lesions of the iliac axis, but difficulties persist with achieving adequate results over the medium and long term when treating extensive occlusive disease. Arterial bypasses to alternative vicarious arteries of the femoral-genicular complex for limb salvage are well known in the literature describing cases that are not favorable for conventional or endovascular surgery. We describe the case of a patient with extensive aortoiliac occlusive disease treated with an arterial bypass in the iliofemoral territory, using an alternative autologous substitute and the descending lateral femoral artery as recipient artery. Alternative bypasses and substitutes that are normally reserved for exceptional cases can and should be part of the vascular therapeutic arsenal and have a contribution to make in cases in which endovascular surgery does not yet enable us to achieve good results.

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

Application of computer assisted technique to desgin polyfoliate perforator flappedicled on the descending branch of the circumflex femoral lateral artery

Objective To explore the feasibility of three-dimensional visualizational reconstruction and virtualization simulated operation of polyfoliate perforator flap pedicled on the descending branch of the circumflex femoral lateral artery. Methods Between October, 2014 and July, 2015, a series of DICOM images were obtained from 12 patients by DSA and dual source CTA. Then the mimics 16.0 was been used to reconstruct the descending branch of the circumflex femoral lateral artery and its perforator vessels. The procedure of free polyfoliate perforator flap pedicled on the descending branch of the circumflex femoral lateral artery had been simulated in personal computer. According to design in the computer, the polyfoliate perforator flaps were designed and dissected for 12 patients who had combined with the huge or irregular wound. Results The 3D reconstruction models could provide perfectly dynamic visualization of the anatomy of the descending branch of the circumflex femoral lateral artery and clearly display three-dimensional relations of blood vessels, skin and adjacent tissue. The procedure of the free polyfoliate perforator flap transfer could be virtually simulated through the mimics soft in the personal computer. Twelve polyfoliate perforator flaps pedicled on the descending branch of the circumflex femoral lateral artery had been transfered with the methods all of flaps were successful survival and donor sites had been directly closed. All patients were followed-up with 1-5 months (mean 3.6 month). The appearance of flaps were satisfactory. Conclusion The 3D reconstruction models can provide a perfect dynamic visualization of the anatomy of the descending branch of the circumflex femoral lateral artery and its perforator vessels which can be used for individualized design of the Polyfoliate perforator flap pedicled on the descending branch of the circumflex femoral lateral artery. Key words: Circumflex femoral lateral artery; Perforator flap; Three-dimensional reconstruction; Angiography; Microsurgical operation