Lateral Perforator Research Articles

Abstract P4-13-10: An evaluation of patient reported outcomes following oncoplastic breast conserving surgery with a crescent modification of the chest wall perforated flap utilizing Breast Q

Abstract Background: An increasing acceptance of chest wall perforator flaps has provided additional options for enhancing the cosmetic appearance of the conserved breast after breast cancer surgery. Traditional lateral intercostal anterior perforator (LICAP) flap involves a lateral chest wall scar. To enhance the cosmetic results of LICAP flap, we propose the crescent modification of the LICAP flap to conceal the scar in the inframammary crease. Aim: The aim of our study was to investigate patient satisfaction and cosmetic outcome by using the BREAST-Q after undergoing crescent-modification of LICAP flap partial breast reconstruction. Methods: All eighteen consecutive patients with who underwent crescent modification of LICAP flap reconstruction for partial breast reconstruction after wide local excision of breast cancer between June 2017 and July 2019 were invited to complete the BREAST-Q questionnaire. All patients were prospectively evaluated and their demographic, clinical and pathological details were recorded on a database. Results: The median psychological, physical and sexual well-being scores were 93 (IQR 63-100), 82 (IQR 69-95) and 70 (IQR 46-96) respectively. The median satisfaction score with breast was 88 (IQR 66-100) Conclusions: In a carefully selected group of women with breast cancer, our study demonstrates that the crescent-modification of the LICAP flap for partial breast reconstruction provides a safe and effective technique with preservation of satisfaction with breast, physical, psychological and sexual well-being. Citation Format: Amtul R Carmichael, Amtul Shafee Sami, Kefah Mokbel. An evaluation of patient reported outcomes following oncoplastic breast conserving surgery with a crescent modification of the chest wall perforated flap utilizing Breast Q [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-13-10.

Clinical Impact of DIEP Flap Perforator Characteristics – A Prospective Indocyanine Green Fluorescence Imaging Study

The question to what extent perfusion in deep inferior epigastric perforator (DIEP) flaps depends on specific perforator characteristics has been raised. Anatomical studies and previous clinical trials focussing on DIEP flap perfusion resulted in discrepancies. This prospective study investigates how perforator row, number and diameter affect DIEP flap microperfusion via Indocyanine Green (ICG) fluorescence angiography. The fractional weight of insufficiently perfused flap tissue in Zone 4 related to the total DIEP flap weight was measured based on ICG fluorescence angiography and defined as Zone 4 %. As a surrogate for overall DIEP flap perfusion, Zone 4 % was assessed according to the row, number and diameter of perforators included in the flap. In 42 unilateral DIEP flap breast reconstructions, neither medial (33.6 ± 14.2 %)/lateral perforator row (29.9 ± 7.5 %, p = 0.683) nor the parameter perforator number (single perforator 31.5 ± 14.4 %, two perforators 30.2 ± 10.2 %, p = 0.727) had a statistically significant effect on flap tissue availability as measured via Zone 4 %. A negative correlative trend between perforator diameter and Zone 4 % (r = -0.096, p = 0.588) was observed. Zone 4 % provides a novel method for an objective assessment of DIEP flap perfusion. Medial/lateral row selection and other perforator properties (number, diameter) within the standard ranges, did not affect Zone 4 % as indicated by ICG fluorescence angiography.

Nipple-Areola Complex Ischemia or Necrosis in Freestyle Perforator Flap Reduction Mammoplasty Operations.

Necrosis of the nipple-areolar complex (NAC) is one of the most devastating complications of reduction mammoplasty. A variable, asymmetrical pattern of blood supply from the main sources was found in the same individual. To solve this problem, we present a method to be sure that the blood supply to the NAC is contained within the designed pedicle during reduction mammoplasty. This is done using the colored duplex scan and handheld Doppler to perform freestyle perforator flap reduction mammoplasty. This is a prospective randomized study that has been performed on 105 patients in the period between January 2014 and 2019 at the Plastic and Reconstructive Surgery Department, Tanta University Hospitals. Freestyle perforator flaps were performed for all cases after perforator detection using handheld Doppler and confirmed by colored duplex scan. The procedure was performed as freestyle on medial perforators in 35 (33.3%) cases, on lateral perforators in 20 (19%) cases, on combined medial and lateral perforators, as a bipedicle in 30 (28.7%) cases, on upper pole perforators in 12 (11.4%) cases, and on lower pole perforators in 8 (7.6%) cases. The use of handheld Doppler and the confirmation by duplex scan are mandatory to decrease the incidence of NAC necrosis or ischemia. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

Lateral Intercostal Artery Perforator Flap: A Single Surgeon Experience and Review of the Literature for Partial Breast Reconstruction

Lateral Intercostal Artery Perforator Flap: A Single Surgeon Experience and Review of the Literature for Partial Breast Reconstruction

Upper body lift and breast reshaping with lateral chest wall perforator propeller flap following massive weight loss

After massive weight loss (MWL), female patients often develop upper trunk laxity and severe breast deformities. Usually several procedures are required to address upper body contouring issues. To achieve better breasts and improve upper body contour, the authors employed a combined approach, associating lateral chest wall perforator propeller flaps with an upper bodylift (UBL). Between September 2015 and March 2017, nine post-bariatric patients underwent simultaneously an UBL and autologous augmentation breast reshaping with lateral chest wall perforator propeller flaps. The authors analyzed the clinical indications, results and complications of this procedure. Eighteen lateral perforator propeller flaps for autologous breast augmentation-mastopexy associated with an UBL were performed successfully. Mean pre-MWL body mass index (BMI) was 54.3±10.9kg/m2, with a mean preoperative pre-UBL BMI of 28.7±3.6kg/m2. The average weight loss before surgery was 67.7±22.4kg. The flaps were harvested on intercostal and/or lateral thoracic arteries. All donor sites had been closed primarily. Following the classification of Dindo and Clavien, four minor complications (I, II), and two major complications (IIIb), including two hematomas requiring reoperation, were reported. No flap necrosis occurred. Follow-up averaged 27.9±8.4months. The patients' satisfaction with their improved breast shapes and chest wall contours was "good", with an aesthetic outcome mean ranked 3.8±0.8 (out of 5). After MWL, upper body deformities can be treated safely and reliably by a combined approach, associating an UBL and autologous lateral chest wall perforator flaps to provide more natural and durable breast shapes, as well as an upper circumferential reshaping.

Treatment of 12 patients with diabetic foot ulcers by VSD combined with anterior lateral perforator flap

To explore the clinical efficacy of VSD vacuum suction combined with anterolateral thigh perforator flap in repairing diabetic foot ulcer. From June 2015 to December 2017, 12 patients with diabetic foot, including 8 males and 4 females, with an average age of 57.4 years old (ranged 49 to 71 years old) and ulcer formation time (1 month to 2 years) were analyzed retrospectively. The wound area of ulcer ranged from 3 cm×5 cm to 7cm×10 cm. All the patients were treated with debridement and VSD negative pressure aspiration, washing with Chinese medicine lotion and flap repair. The survival, appearance and sensory recovery of the flap were observed. All 12 flaps survived after operation, and the wounds were successfully repaired. The donor site healed well. During the follow-up of 6 to 18 months, the flaps of 12 patients survived well and their appearance was satisfactory, sensory partial recovery. The clinical effect of VSD negative pressure drainage combined with anterolateral femoral perforator flap after debridement of diabetic foot ulcer is satisfactory and worth popularizing.

Rezoning Free Muscle-Sparing Transverse Rectus Abdominis Myocutaneous Flaps Based on Perforasome Groupings and a New Understanding of the Vascular Architecture of the Deep Inferior Epigastric Artery-Based Flaps.

We compare the vascular territory of free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps, deep inferior epigastric perforator (DIEP) flaps, and crossover anastomosis (CA) flaps using intraoperative ex vivo angiography. We also use ex vivo angiography to analyze the vascular architecture of the MS-TRAM flap. Our study includes 84 lower abdominal free flaps: MS-TRAM, DIEP-1 (1 perforator), DIEP-2 (2 perforators), and CA. We compare the arterial perfusion area and vascular territory pattern in each group. We also analyze the vascular architecture in MS-TRAM flaps and determine the number and location of their dominant perforators and the direction of the axial arteries connecting them. The CA's arterial perfusion area is the largest, and the DIEP-1's, the smallest of our groups; there is no statistically significant difference between MS-TRAM and DIEP-2. In all groups, average arterial perfusion area in the vascular pedicle's ipsilateral side is larger than in its contralateral side. The MS-TRAM and DIEP-2 flaps have homologous perfusion patterns and the same arterial perfusion areas. The DIEP-1 perfusion pattern varies with perforator location. Ex vivo angiograms show the MS-TRAM flap's axial arteries heading laterally to be larger and longer than those heading medially. Two dominant perforators are preferable in DIEP flap breast reconstruction. Lateral perforators play a more important role in flap perfusion than do medial ones. Crossover anastomosis is an effective technology for increasing arterial perfusion areas. Our rezoning shows which areas are better for surgery and which have a high risk of complications-valuable information for a surgeon designing a flap for breast reconstruction.

Clinical application of lateral supramalleolar perforator flap with the rotation point down on the repair of forefoot soft tissue defect

Objective To investigate the clinical effect of lateral supramalleolar perforator flap with the rotation point down on the repair of forefoot soft tissue defect. Methods From January, 2016 to June, 2017, 23 cases(15 males and 8 females) of forefoot soft tissue defect were repaired by lateral supramalleolar perforator flap with the rotation point down. The age ranged from 8 to 67 (mean, 42.9) years. The soft tissue defects were located far from the tarsometatarsal joint of the foot and the areas were 4.0 cm×4.0 cm-8.0 cm×12.0 cm. The areas of flap stitched directly or take blade thick skin repair on the thigh. All cases were followed-up by telephone or Internet, outpatient visit and home visit. Results Twenty-one cases survived successfully. Small area necrosis occurred at the distal end of the flap in 1 case, and healed after changing treatment. In the other cases, tension blister appeared at the distal end of the flap. After cut off some surgical stitches, the flap survived. All cases were followed-up from 6 to 12 months. The shape of flaps were not bloated and had good textures. The walking of affected limbs had no significant effect, and the functional recovery was satisfactory. Conclusion The lateral supramalleolar perforator flap is easy to cut and the perforator of flap is constant, which is a appropriate flap to repair the soft tissue defect of the forefoot. Key words: Lateral supramalleolar perforator flap; Rotation point; Forefoot; Soft tissue defect; Repair

Effect of lateral malleolus perforator flap for the repair of soft tissue defect of foot and ankle

Objective To study the effect of lateral supramalleolar perforator flap for skin and soft tissue defect of lateral malleolus. Methods From January 2012 to December 2015, 36 patients with soft tissue burn of ankle in the Traditional Chinese Medicine Hospital of Cixi were selected as study objects.The average wound area was 4~10cm.The average flap size was 5~13cm.There were 17 cases received skin flap of behind perforator of the lateral malleolus.There were 19 cases received skin flap of front perforator of the lateral malleolus.The effect of repair was observed. Results All flaps survived in 36 cases after operation.There were 7 cases of 2.6cm of blood stasis, and necrosis occurred in 2 cases which healed after dressing change.Transplantation of skin flap and the original skin had good adhesion, skin color and texture was similar to the surrounding skin during the follow-up period of 6 to 12 months.The survival time and walk time of the repair of anterior perforator flap were (2.20±0.70)weeks, (4.70±1.10)weeks, respectively, which were longer than those of the lateral retromalleolar perforator flap[(2.10±0.80)weeks, (4.20±1.10)weeks], but the differences were not statistically significant (all P>0.05). The American orthopaedic foot and ankle society(AOFAS) score of the anterior perforator flap was significantly lower than that of the lateral retromalleolar perforator flap, the difference was statistically significant[(77.47±3.41)points vs.(80.12±4.12)points, t=2.110, P<0.05]. Conclusion Lateral supramalleolar perforator flap has significant effect for skin and soft tissue defect of lateral malleolus.The operation is simple, the success rate is high, it is worth to be popularized in clinical. Key words: Ankle injuries; Soft tissue injuries; Surgical flaps; Reconstructive surgical procedures

The Lateral Thigh Perforator Propeller Flap

The Lateral Thigh Perforator Propeller Flap

Elevation Technique for Medial Branch based Superficial Circumflex Iliac Artery Perforator flap.

According to early studies on the superficial circumflex iliac artery perforator flap, there are two major types of perforators that are presumed to originate from the superficial circumflex iliac artery: the medial perforator with a direct cutaneous vessel (superficial branch) - located relatively medially on the flap, and the lateral perforator, traveling laterally beneath the deep fascia and often with an intramuscular pathway penetrating the deep fascia on the lateral aspect (deep branch) of the flap. Although there are well described studies on the anatomy of the arterial vasculature, design and elevation of the flap are different issues, as there are always some potential for anatomical variations, such as pedicle anatomy, location of lymph nodes, and thickness of superficial fascia. The presence of internal pudendal artery and superficial inferior epigastric artery in the groin may add to the confusion. One should also beware of the presence of major lymphatics which are drained into the superficial venous system. Therefore this paper will try to simplify the elevation technique based on the medial perforator. However, one must always be ready to identify a good perforator and to elevate it as a freestyle approach to overcome the variations wherever the perforator may originate from. The best way to feel comfortable using any flap is from practice and repetitive elevation. The same is for the medial branch based SCIP flap. The direct cutaneous nature of the pedicle will make the dissection even easier as the dissection course bypasses muscle and lymph nodes. This technical note describes practical surgical tips for elevating the medial perforator based SCIP flap.

Different reverse points of forward lateral malleolus perforator flap in the repair of skin and soft tissue defect of ankle or dorsal foot

Objective To discuss the clinical effects of forward lateral malleolus perforator flap in the repair of skin and soft tissue defect of ankle or dorsal foot. Methods From November, 2014 to June, 2017, 16 cases of skin and soft tissue defect in ankle or dorsal foot had been repaired, which were 11 males and 5 females, aged from 25 to 58 years old(average, 32.5 years). The rotation points were on proximal 5 cm of the lateral malleolus in 11 cases and on the level of tarsal sinus in 5 cases. The largest flap was 10.0 cm×18.0 cm and the smallest flap was 6.0 cm×4.0 cm. The color, thickness, texture, sensation, appearance, donor site shape and functional were followed-up after operation. Results All the 16 patients were followed-up from 1 to 24 months. The distal flap appeared dark in 1 case 2 days after operation, and blood supply was improved after stitches; One case was superficial necrosis and healed after dressing. All the flaps had good appearance and texture, no pigmentation, scar contracture, and so on. Conclusion The forward lateral malleolus perforator flaps have perforator constantly and the color, thickness are similar with the receiving areas, the rotation point could on proximal 5 cm of the lateral malleolus and on the level of tarsal sinus, which is a good method to repair skin and soft tissue defect of ankle or dorsal foot. Key words: Forward lateral malleolus perforator flap; Dorsal foot; Ankle; Skin and soft tissue defect; Repair

Mastopexie nach massivem Gewichtsverlust – Erweiterte Ribeiro-Technik und Einsatz der lateralen Interkostalarterien-Perforatorlappenplastik (LICAP-Flap) zur Autoaugmentation

Mastopexy in massive weight loss patients is challenging. The breast mound is often unstable and deflated, with a loose inelastic skin envelope. It has become apparent that mammaplasty techniques in these cases should rely more on glandular recontouring rather than on the skin envelope for shaping. Published methods include plication, suspension and autoaugmentation. The residual local tissue (glandular breast tissue, fat tissue, dermoglandular fat flap) is utilised to its full extent in order to reshape a form-stable breast with full upper pole projection. The evolution of a technique is presented. In this study we retrospectively analysed 68 massive weight loss patients who underwent an extended Ribeiro technique with a superomedial pedicle mastopexy and suspension by an inferior dermoglandular flap. The current procedure involves incorporating the lateral intercostal artery perforator flap (LICAP flap) and medial breast pillar additionally to the inferior dermoglandular Ribeiro flap. This essentially autoaugments the upper pole by creating an "autoprosthesis", narrows the widened breast, and redefines the inframammary fold. The outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensibility and surgical revision rate were obtained. From 01/2011 to 12/2016, we performed 136 autoaugmentation mastopexies. The average age was 41.2 years, average body mass index (BMI) was 27,1 kg/m2, average weight loss was 54.3 kg, average sternal notch-NAC distance was 32.3 cm, average operation time was 109 minutes. In 12 breasts, a free-nipple graft was necessary. The complication rate was 5.1 %, surgical revision rate was 17.6 %. 95 % of the patients were "very satisfied" or "satisfied" with the aesthetic result. Nipple sensibility was rated as "very good" or "good" by 85 % of patients. Modification of the Ribeiro technique by using the medial and lateral breast pillar (LICAP flap) allows autoaugmentation of the upper pole. Parenchymal shaping through plication and suspension of the breast mound should improve breast shape over time, with the aim of reducing the incidence of recurrent ptosis. The presented technique is a reproducible and reliable method with a low complication rate.

Lateral Intercostal Perforator Flap Letter Response.

Lateral Intercostal Perforator Flap Letter Response.

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 application of pedicled anterolateral thigh propeller flaps in reconstruction of inguinal skin and soft tissue defects

Objective To discuss the effectiveness of anterolateral thigh propeller flaps for treatment of inguinal skin and soft tissue defects. Methods From June, 2009 to October, 2014, 12 patients with inguinal skin and soft tissue defects were treated with anterolateral thigh propeller flaps pedicled with perforator of descending branch of lateral circumflex femoral artery. Of them there were 8 males and 4 females, aged from 22 to 51 years. The left side was involved in 3 cases and right side 9 cases. Defects were caused by traffic accident injury in 5 cases, crash injury of heavy object in 7 cases. There were mere skin and soft tissue in 2 cases, combined with bone fractures, nerves, vessels and muscles injury in 10 cases. The area of defects ranged from 9.0 cm×5.0 cm to 22.0 cm×9.0 cm. During operation, anterolateral thigh propeller flaps ranging from 11.0 cm×7.0 cm to 24.0 cm×11.0 cm were used to repair the wounds. Results All flaps and skingrafts survived after operation and the wounds obtained primary healing. After 8-24 months follow-up, all flaps were characterized by soft texture, good color, and satisfactory appearance. According to the Britain’s Medical Research Council at 8 months after operation, the sensation of the flaps were recovered to S2~ S3+, No obvious scar contracture and chromatosis were observed at donor site. Conclusion Anterolateral thigh propeller flaps pedicled with artery descending branch of lateral circumflex femoral perforator is an ideal choice for the reconstruction for inguinal skin and soft tissue defects. Key words: Anterolateral thigh flaps; Propeller, perforator flaps; Descending branch of lateral circumflex femoral artery; Inguinal; Repair

Application of microdissected thin anterior lateral thigh perforator flap in precise microsurgical reconstruction of oral and maxillofacial soft tissue defects

Objective To investigate the application of microdissected thin anterior lateral thigh perforator flap (ALTP flap) in precise reconstruction of oral and maxillofacial soft tissue defects and to assess the clinical reconstruction outcome. Methods From January, 2014 to September, 2015, utilizing the technique of microdissected thin anterior lateral thigh flaps to repair the defects resulted from radical resections of primary sites in 42 patients with oral cancer. Before the operation, the dominant perforator was detected and marked on the skin where the planned flap would be harvested later by Doppler probing. Initial incision was made medial to the perforator marker. Careful dissection was conducted suprafascially to isolate the dominant perforator as well as identifying its source and type. The size of flap was determined according to the area of defect after tumor ablation. Meanwhile the flap was thinned in accordance with the contour of the defect or the organ to be reconstructed. The procedure should be performed under operating microscope. Results Forty-five microdissected thin ALTP flaps were harvested and used to reconstruct the defects of tongue, buccal, oral floor, and gingiva in 42 patients. Among them, 28 flaps were nourished by single perforator, 14 flaps were nourished by 2 perforators, and 3 flaps were nourished by 3 perforators. In total, 65 perforators were identified, in which 28 were direct cutaneous branches, 13 were fascia-cutaneous branches, and 24 were fascia branches. One take-back occurred within 6 hours due to cervical haematoma. During re-exploration, pedicle compression was found. And the flap was salvaged successfully after haemotoma removement and proper bleeding point ligation. Four flaps underwent marginal necrosis which healed smoothly after debridement and dressing changes. Post-operative 6 to 24 months’ follow-up showed satisfactory appearance of the recipient sites with favorable speech and swallowing function. All donor sites were closed primarily, leaving no donor-site complications including incision disruption, scar hyperplasia or muscle strength degeneration of the lower limb. Conclusion Microdissected thin anterior lateral thigh perforator flap is an optimal choice for personalized reconstruction of soft tissue defects of the tongue, buccal, oral floor, and gingiva, for it can decrease donor-site morbidity and achieve better appearance and function reconstruction effect of the recipient site. Key words: Oral and maxillofacial defects; Anteriolateral thigh flap, perforator flap; Microdissected thin flap; Microsurgical technigue

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

In Vivo Changes of Breast Perfusion After Augmentation.

Revision surgeries after breast augmentation are associated with an increased risk of complications (eg, nipple areolar complex [NAC]) necrosis. Consequently, maintaining perfusion to the NAC is a critical aspect of secondary breast surgery. The purpose of this study was to examine in vivo changes in perfusion to the NAC after implant breast augmentation using magnetic resonance imaging (MRI) technology. High-resolution 3 Tesla MRI images of 10 women (20 breasts) with previous breast augmentation were compared to a control population of 15 women (30 breasts). Perforators from the internal mammary artery and lateral thoracic artery were examined for the diameter of the originating perforator, distance between the nipple and most distally visualized point of the medial and lateral perforator, and dominance pattern between the medial vs lateral perforators. No difference was found in the caliber of the medial vessels in the implant group compared to the control group. In contrast, the caliber of the lateral blood vessels trended towards being 20% larger in diameter in the augmented breasts. The distances between the nipple and the medial and lateral vessels increased. The frequencies in the distribution of dominance were not significantly different between the implant group and the control group. Overall, medial and lateral blood supply to the NAC are preserved in the augmented patient. Our results suggest a slight delay effect that seems to increase the caliber of the lateral perforators. In addition, the tissue expansion provided by the implants effectively increases the length of both perforators. 3 Therapeutic.

Superficial lateral sural artery perforator flap for hand reconstruction

Objective To investigate the clinical efficacy of superficial lateral sural artery perforator flap for hand reconstruction. Methods From March, 2012 to April, 2015, 15 superficial lateral sural artery perforator flaps were planned for hand reconstruction. Of all cases, 11 cases were male, 4 cases were female, age ranged from 21 to 51 years old, with average age of 38.2 years. The skin defects ranged from 1.5 cm × 3.5 cm to 5.0 cm × 6.5 cm. Superficial lateral sural artery perforator flap were harvested uneventfully in 12 cases, the flaps were converted to superficial medial sural artery perforator flap in 3 cases. The flap size ranged from 1.8 cm × 3.8 cm to 5.5 cm × 6.5 cm. All reconstructive surgeries were performed secondarily. Results All of 15 flaps survived well, all donor sites were closed directly. During a mean follow-up of 9 months, the flaps were thin and pliable, none of the patients needed secondary flap thinning. The appearance of donor site was satisfactory, no patients complained about functional restrictions. Conclusion The superficial lateral sural artery perforator flap is feasible for reconstruction of middle-sized defects of the hand. Key words: Hand; Perforator flaps; Superficial sural artery; Microsurgery