Lateral Femoral Circumflex Vessels Research Articles

Anterolateral thigh flap: A review of 168 cases.

The anterolateral thigh flap based on the descending branch of the lateral circumflex femoral vessel is one of the musculocutaneous or septocutaneous flaps in the thigh. The descending branch of the lateral circumflex femoral vessel has either perforating branches or direct cutaneous branches from the intermuscular space to the anterolateral femoral skin. Since 1983, we have transferred 168 anterolateral thigh flaps for reconstruction of old burn scars, infected wounds, carcinoma excisions, for coverage of open bone fracture of the lower leg, and for congenital diseases. One hundred fifty-two cases were free flaps. The other 16 cases were pedicled flaps. The skin branches were divided into four types in our clinical series: musculocutaneous perforators (135/168 [80.4%]); intermuscular cutaneous perforators (16/168 [9.5%]); direct cutaneous branches (14/168 [8.3%]); and tiny cutaneous perforators (3/168 [1.8%]). The results were satisfactory. Only one case resulted in a failure due to tiny cutaneous branches.

Combined anterior thigh flaps and vascularised fibular graft for reconstruction of massive composite oromandibular defects

Six massive, composite oromandibular defects were reconstructed using combined anterior (anterolateral and anteromedial) thigh flaps and vascularised fibular graft in bridge or chimeric fashion. Except for minor dehiscence in one case and infection in another, all flaps survived without complication. Anterior thigh flaps provide large-calibre, long vascular pedicles while derivative branches from the lateral circumflex femoral system facilitate simultaneous transplantation of multiple components. Because the pedicle of the vascularised fibular graft is of insufficient length, the lateral circumflex femoral vessels provide a remote vascular source as a flow-through vascular conduit. A combined flap using the lateral circumflex femoral system is considered to be most suitable for reconstruction of through-and-through defects of the head and neck. The authors describe the advantages of this method and the detailed anatomy of the cutaneous perforators of the anterior thigh flaps.

A surgical guide for identifying the lateral femoral circumflex vessels during free vascularized fibular transfer for avascular necrosis of the femoral head.

Free vascularized fibular transfer for avascular necrosis of the femoral head was developed in an attempt to preserve, rather than replace, the femoral head. In this procedure, the peroneal vessels of the autogenous fibular graft are anastomosed to recipient branches of the lateral femoral circumflex vessels. A problem with this procedure has been the difficulty in locating the lateral femoral circumflex vessels. An anatomic and surgical study was conducted to seek a consistent anatomic landmark for use in isolating these vessels. Ten cadaveric and 29 surgical hip dissections were performed. A falx, or fascial band, was consistently found approximately 10 cm distal to the anterior superior iliac spine; it is attached to the anterior intertrochanteric line of the proximal femur, with additional attachments to the investing fascia of the tensor fascia lata and rectus femoris muscles. Cautious release of this falx from superficial to deep leads to the fat layer surrounding the lateral femoral circumflex vessels. This study has shown that an anatomic landmark exists, which consistently leads to location of the lateral femoral circumflex vessels during a free vascularized fibular transfer. By incorporating the use of this landmark ito the authors' surgical technique, they have significantly reduced surgical dissection time and have provided a safe method for isolating the recipient vessels during this challenging operation.

Application of the ilium transposition flap based on the ascending lateral femoral circumflex vessels to treat hip bone diseases. (Chinese)

Application of the ilium transposition flap based on the ascending lateral femoral circumflex vessels to treat hip bone diseases. (Chinese)

Applied Anatomy of the Anterolateral Femoral Flap

A study of the source of the blood supply to the anterolateral femoral flap was carried out on 42 lower limbs of adult cadavers (among them 35 cadavers with injection of red latex and 1 with india ink into the arteries and 6 vascular cast specimens), and the surface locations of the vascular pedicle were detected on 50 healthy adults. It was found that the descending branch of the lateral circumflex femoral vessel was an ideal axial vessel. There are constant perforating branches of the myocutaneous artery or cutaneous branches from the intermuscular space to the anterolateral femoral skin. The area extends about 12 x 30 cm. Within the flap, the anterior branch of the anterolateral cutaneous nerve of the high is located. This flap has been widely used for free transplantation in China since 1983 with satisfactory results.

THE SENSORY NERVES OF THE HIP JOINT

Nerve Supply to the Ventral Aspect of the Hip Joint 1. The articular branch of the obturator nerve to the ventral aspect of the coxofemoral joint is almost constant (98 per cent. ± 2). 2. The articular branches arise more frequently from the trunk of the obturator nerve (71.64 per cent. of the cases ± 6.4) than from either the posterior (23.37 per cent. ± 6.2) or the anterior branch (2.98 per cent. ± 2.4) of the obturator nerve. 3. The articular branch of the obturator nerve is single in 67.34 per cent. ± 6.7 of the cases in 28.57 per cent. ± 6.4 there are two articular branches, and in 4.08 per cent. ± 2.8 there are three. 4. The articular nerves may be of two types,—that is, capsular (penetrating the capsule), and acetabular (penetrating the incisure of the acetabulum). 5. The capsular branch is present in 93.87 per cent. of the cases; it was missing in only three of our specimens; only the acetabular branch was present in these. The acetabular branch is present in 59.18 per cent. ± 6.9 of the cases. It arises directly from the trunk or from the terminal branches of the obturator nerve in 14.28 per cent. ± 4.9 of the cases; from the nerve to the external obturator muscle in 18.36 per cent. ± 5.5; from the capsular branch in 26.53 per cent. ± 6.2. 6. A common origin of branches from the obturator nerve was found as follows: articular branch and nerve to the external obturator muscle, in 44.98 per cent. ± 7.1 of the cases capsular, acetabular, and muscular branches, in 12.24 per cent. ± 4.6; acetabular and muscular branches, in 20.4 per cent. ± 5.8; capsular and muscular branches, in 12.24 per cent. ± 4.6. 7. The origin of the articular branches of the obturator nerve is proximal to the obturator canal (that is, in the pelvic cavity) in 40.29 per cent. ± 7; at the level of the internal orifice of that canal, in 26.86 per cent. ± 6.3; within the canal, in 17.61 per cent. ± 5.4; at the level of its external orifice, in 14.42 per cent. ± 5.1. 8. When present, the accessory obturator nerve may or may not give off filaments to the coxofemoral joint. It was present in two of our specimens and contributed to the innervation of the joint in one case. 9. No direct articular branches from the femoral nerve were found. There are, however, nerve filaments arising from the nerve to the pectinaeus muscle, which follow the medial circumflex vessels, as well as twigs from the nerves to the vastus lateralis, intermedius, medical, and rectus femoris muscles, which follow the lateral femoral circumflex vessels. Innervation of the Dorsal Aspect of the Hip Joint 1. The dorsal aspect is supplied in all cases by one or more branches arising from the nerve to the musculus quadratus femoris and musculus gemellus inferior. We suggest for the latter the name musculo-articularis of the sacral plexus. In only two instances was there a concomitant branch directly from the sciatic nerve. 2. The nervus musculo-articularis originates most frequently from the sacral plexus (69.81 per cent. ± 6.3); next most frequently from the initial portion of the sciatic nerve (24.52 per cent. ± 5.9); or from the tibial branch of the sciatic nerve (5.66 per cent. ± 3.2), in cases of high division of the latter. 3. The nervus musculo-articularis arises from the anterior aspect of the transitional segment between the sacral plexus and the sciatic nerve, at a point in the transverse plane somewhere between the lateral and the medial margin. 4. The origin of the nervus musculo-articularis occurs most frequently proximal to the interior outline of the ischiatic foramen (37.73 per cent. ± 2.4); at its level, in 30.18 per cent. ± 6.3; distal to it, in 32.07 per cent. ± 6.4. The maximum distance between this origin (either proximal or distal) and the inferior outline of the ischiatic foramen was 25 millimeters. 5. The initial of the nervus musculo-articularis, from its origin down to the upper margin of the musculus gemellus superior, is the part most accessible to the surgeon and might be called its surgical segment. It may measure between 3 and 45 millimeters in length.