Lateral Thigh Perforator Research Articles

Microsurgical breast reconstruction in the United States: a narrative review of the current state.

Breast reconstruction with microsurgical techniques allows for autologous reconstruction after mastectomy without the complications associated with alloplastic reconstruction. Autologous reconstruction has undergone significant improvement and now offers patients a variety of options depending on patient specific factors and aesthetic outcomes. This review aims to focus on the history of autologous reconstruction, operative considerations, general surgical techniques for flaps, and indications for choosing the ideal free tissue transfer for all medical specialties and not only plastic surgeons. A comprehensive review of the literature was performed using PubMed and Embase databases. Manuscripts that provided objective data with respect to history of microsurgical options, surgical techniques, patient considerations, and contraindications were utilized for this review with the objective to simplify data for all non-plastic surgeon readers. In this study, we find that patient selection is critical in successful outcomes for microsurgical breast reconstruction. We find that abdominal free flaps are now considered gold standard for autologous reconstruction. However, reliable alternatives exist for patients who are not considered ideal candidates for this reconstruction. These include thigh-based flaps such as gracilis myocutaneous flaps, profunda artery perforator flaps, lateral thigh perforator flaps and trunk-based flaps such as lumbar artery perforator flap. Postoperative considerations involve clinical monitoring and enhanced recovery after surgery. The rate of reconstructive success and flap viability is greater that 95%, even in high-risk populations, and therefore risk stratification should be performed based on an individual basis. While there are no absolute contraindications to autologous reconstruction, relative contraindications do exist including obesity and elderly populations due to the increased surgical and medical complications. While implant-based reconstruction remains the predominant method of breast reconstruction in the United States, there have been many exciting advancements in autologous reconstruction that offers high aesthetic outcomes and patient satisfaction.

Lower Abdominal vs. Lateral Thigh Perforator Flaps in Microsurgical Sarcoma Reconstruction: The Aesthetics of Donor Site Matters.

Introduction: Sarcoma resection often leaves patients with big defects only amenable through microsurgical reconstruction. In such cases, it is hard for the surgeon to uphold low donor-site morbidity with an aesthetic result. The purpose of this study was to investigate the clinical outcome and the patient's perception regarding the donor site in a cohort of patients undergoing microsurgical reconstruction with lateral thigh and lower abdominal perforator flaps. Methods: A retrospective evaluation of all patients who underwent sarcoma reconstruction with flaps harvested from the lower abdominal region (deep inferior epigastric artery perforator flap, superficial circumflex iliac artery perforator flap) or lateral thigh region (anterolateral thigh perforator flap and its variations) was performed. Only patients with defects greater than 100 cm2 were included. Patient demographics and operative variables were recorded, together with complications. Patient satisfaction and quality of life with the donor site were registered using the SCAR-Q questionnaire, which was administered at least six months post-operatively. Results: Eighteen anterolateral thigh (ALT) perforator flaps and twenty-two deep inferior epigastric artery perforator (DIEP) and superficial circumflex iliac artery perforator (SCIP) flap procedures were performed. The two groups were homogeneous for major post-operative complications (p > 0.999). Patient satisfaction with the donor site measured using the SCAR-Q questionnaire showed significantly higher scores in the DIEP/SCIP group when compared with the thigh group (p < 0.001), indicating a superiority of the lower abdominal area as an aesthetic donor site. Conclusions: The DIEP and SCIP flaps are a versatile option for reconstructing large soft-tissue defects following sarcoma resection. Therefore, flaps harvested from the lower abdomen yield a higher patient satisfaction with the donor site, which is a feature worth considering when planning a reconstructive procedure.

Introduction of the L-PAP Flap: Bipedicled, Conjoined, and Stacked Thigh-Based Flaps for Autologous Breast Reconstruction.

Thigh-based flaps are increasingly popular options for autologous breast reconstruction in the setting of abdominal donor-site inadequacy, previous surgery, or patient preference, but the volume and skin associated with these flaps are often lacking relative to the abdomen. An individualized, shared decision-making approach to donor-site selection was adopted based on body shape, surgical history, lifestyle, reconstructive needs, and patient expectations. Different thigh-based flaps combined in stacked, bipedicled, or conjoined configurations were selected to maximize efficient use of available soft-tissue skin and volume while optimizing donor-site aesthetics. A total of 23 thigh-based stacked, bipedicled, or conjoined profunda artery perforator (PAP), lateral thigh perforator (LTP), or gracilis musculocutaneous flap components were used in six patients. Configurations included bilateral stacked PAP and LTP flaps, bipedicled posterolateral thigh flaps based on the LTP and PAP (L-PAP), and bipedicled thigh flaps based on the gracilis and PAP pedicles. Most anastomoses were performed to the antegrade and retrograde internal mammary vessels; intraflap anastomoses were performed in one case. There were no partial or total flap losses. There was one donor-site seroma. Design of stacked, bipedicled, and conjoined thigh-based flaps using multiple conventional flap components allows for tailored approaches to donor-site utilization based on individual body shape in selected patients. Bipedicled design with the L-PAP flap represents one strategy in appropriate cases to overcome skin and volume deficiencies while facilitating coning and projection. Therapeutic, IV.

Does Fitzpatrick Score Predict Flap Loss? Microsurgical Breast Reconstruction Outcomes of Varying Skin Color.

This is a retrospective study conducted on patients who underwent any type of autologous flap breast reconstruction performed by the two senior authors at an academic center between January 2010 and December 2021. The sole primary outcome variable was flap loss. Patient skin tone was assessed using the Fitzpatrick scale on clinical photographs of patients. A total of 1115 pateints underwent autologous flap breast reconstruction, of which only 56 met both exclusion and inclusion criteria with 58 individual breasts being included in the final study population. The most common race of subjects was White (n = 33; 56.9%) while the most common Fitzpatrick score skin tone was type II (n = 22; 37.9%). The Cochran-Armitage test of trend showed a statistically significant linear trend, P = 0.006, with darker Fitzpatrick score skin tones associated with a higher proportion of flap loss in patients who had vascular compromise. A logistic regression showed that none of the predictor variables were significant. Patients with darker Fitzpatrick skin tones were associated with flap loss after vascular compromise. To prevent flap loss in patients who have darker Fitzpatrick score skin tones, more aggressive flap monitoring should be taken into consideration in the immediate postoperative setting.

Breast-related and body-related quality of life following autologous breast reconstruction is superior to implant-based breast reconstruction - A long-term follow-up study

IntroductionThe better survival rates after breast cancer allow for setting of long-term goals, such as Quality of Life (QoL) and aesthetic outcomes following breast reconstruction. Studies find a higher breast-related QoL and greater satisfaction with breasts following autologous breast reconstruction (ABR) compared to implant-based breast reconstruction (IBR). However, aesthetic results from donor sites can influence body image. This concern is little addressed in the literature. Therefore, the aim of this study was to compare the long-term breast-related and body-related QoL of women who underwent ABR to women who underwent IBR. Material and methodsA multicenter, cross-sectional survey was conducted between November and December 2020 among women who underwent postmastectomy breast reconstruction between January 2015 and December 2018. A general questionnaire, the BREAST-Q, and the BODY-Q were used to collect data. Multivariable linear regression was performed to adjust differences in Q-scores for potential confounders. ResultsIn total, 336 patients were included (112 IBR, 224 ABR). Autologous reconstruction resulted in significantly higher mean scores in all subdomains of the BREAST-Q. On the BODY-Q, IBR scored significantly higher on scars, while ABR scored moderately to significantly higher on all other scales. Despite a lower mean score on Hips & outer thighs in women with Lateral Thigh Perforator (LTP) flap reconstruction, no negative influence on body image was found in these women. ConclusionsLong-term breast-related and body-related outcomes of ABR are superior to IBR. Donor site aesthetic does not adversely affect body image in women who underwent free flap breast reconstruction.

Effects of oxidative stress and apoptosis on vascularity and viability of perforator flaps

ABSTRACT We investigated lateral thoracic and posterior thigh perforator flaps for viability, vascularization, perfusion and apoptosis in a rat model. Wistar albino rats were divided into six groups: lateral thoracic artery perforator flap (LTPF) sham, 3 × 2 cm2 LTPF, 3 × 6 cm2 LTPF, posterior thigh perforator flap (PTPF) sham, 3 × 2 cm2 PTPF, and 3 × 6 cm2 PTPF. Flap viability was determined on postoperative days 1 and 7. On day 7, flaps were photographed and their viability was measured using two-dimensional planimeter paper. Tissue samples were harvested for examination by histology and immunohistochemistry. Viability differences were statistically significant. Epithelial thickness, vascularity and number of fibroblasts were reduced in the 3 × 6 cm2 groups. Neovascularization and apoptosis based on molecular tests were not significantly different among groups. Flap size and location are important factors for closure of surgical or traumatic defects. We suggest that for clinical application, wound complications will occur less frequently with perforators that nourish large areas of flaps.

Use of Muscle Feeding Arteries as Recipient Vessels for Soft Tissue Reconstruction in Lower Extremities.

Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction. Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure, especially in an extensive wound, or in a complex trauma combined with vascular injury. From April 2014 to March 2018, we retrospectively reviewed patients with traumatic/post-traumatic, oncologic, and electrical wounds in the lower extremity. Those treated with muscle feeding artery as recipient vessels were included. The latissimus dorsi (LD) muscle free flap, anterior lateral thigh (ALT) perforator free flap, and deep inferior epigastric perforator (DIEP) free flap were raised. The muscle feeding arteries to vastus lateral muscle and to medial head of gastrocnemius muscle, concomitant veins, and great saphenous vein were used as recipient vessels. Injuries included in the study were caused by tumour in 2 cases, car accident in 3 cases, crushing in 3 cases, burns in one case, and electrical injury in one case. The wound size varied from 14 cm × 6 cm to 30 cm × 20 cm. LD, ALT, and DIEP free flaps were used in 6, 3, and 4 patients, respectively. The muscle feeding arteries to medial head of gastrocnemius muscle, to sartorius muscle, and to vastus lateral muscle were used as recipient arteries in 4, 5, and one patient, respectively. Concomitant and great saphenous veins were used as recipient veins in 10 and 4 patients, respectively. Using the muscle feeding artery is feasible to avoid injury to the main artery and facilitate dissection and anastomoses, particularly when the wound is located proximal to the mid-third of the lower leg.

Neurotized Diagonal Profunda Artery Perforator Flaps for Breast Reconstruction.

Summary:Although the deep inferior epigastric artery perforator flap remains the gold standard for autologous breast reconstruction, many patients are not candidates for this surgery. A variety of thigh-based flaps have been used including the diagonal upper gracilis (DUG) flap, vertical upper gracilis flap, profunda artery perforator (PAP) flap, and lateral thigh perforator flap. However, each of these techniques has a unique set of benefits and drawbacks in terms of wound healing, donor site morbidity, and potential for lymphedema. We describe the first report of a sensate diagonal PAP flap for breast reconstruction: combining the benefits of the DUG (wider skin paddle and reliable wound healing) with the benefits of the PAP (muscle-sparing technique and greater distance from the lymphatic collectors). This was the authors' sentinel case in a woman with paraplegia and chronic leg swelling. Preoperative imaging, markings, and technical details are presented along with postoperative results. In the appropriately selected patient, this flap offers several advantages: a 2-team approach to reconstruction, ample tissue for breast reconstruction, potential neurotization for breast sensibility, wound closure in resting skin tension lines, and avoidance of the lymphatic drainage to the lower extremity. The diagonal PAP flap provides a muscle-sparing alternative to the DUG flap while minimizing the risk of lymphedema. Future studies are needed to assess the donor site morbidity of this flap; however, this case proves the safety and reliability of the diagonal PAP flap in our breast reconstruction population.

P3.55: Allointestine colon conduit urinary diversion in combined intestine and kidney transplant: A case report

Introduction: In intestinal transplant candidates, the incidence of renal failure is high and is associated with increased mortality. Additionally previous surgeries and loss of abdominal domain may make standard kidney transplant with ureterocystostomy impossible. . Methods: We present an extreme case of combined small intestine, colon, and kidney transplant in a patient with short gut syndrome due to radiation enteritis, severe loss of abdominal domain, failed previous kidney transplant, and absence of native urinary system. Results: Our patient is a forty years old female with a past history of bladder Rabdomyosarcoma as an infant, who underwent bladder resection and post resection radiation. She developed radiation enteritis, renal failure, and eventually received a living related kidney transplant. Her renal allograft subsequently failed due to multiple urinary obstructions despite multiple revision surgeries, as well as chronic immunosuppression toxicity. As a result, she had short gut syndrome and renal failure with no feasible route of urinary drainage. In addition, she had severe loss of abdominal domain due to abnormal abdominal development from the radiation she received as an infant. She had multiple complications of her short gut syndrome and she underwent a simultaneous small intestine, colon, and kidney transplant. Donor was an eight years old female (132 cm, 23.4 kg), who became brain dead after severe exacerbation of asthma attack. Since there were no viable routes for urinary drainage, as there were no viable native intestines, and native and previous transplanted kidney ureter had been obstructed, a 10 cm allograft colon segment was used as a urinary conduit. The patient also underwent a complex abdominal closure with pedicled left anterior lateral thigh perforator flap by the plastic surgery team. One hundred days post transplant the patient is parenteral nutritional independent with normal renal function and her transplant colon conduit is healthy and functional. Conclusion: In extreme cases of kidney transplant in intestinal transplant recipient patients with no feasible urinary drainage path, transplant intestine can successfully be used as a conduit. In review of literature, and to the best of our knowledge, this is the first description of utilization of allograft intestine as a urinary conduit.

Stacked Lateral Thigh Perforator Flap as a Novel Option for Autologous Breast Reconstruction.

Autologous breast reconstruction using perforator flaps offers excellent outcomes, minimizes donor-site morbidity, and allows for precise donor-site selection. The deep inferior epigastric artery perforator, profunda artery perforator, and gluteal artery perforator flaps along with the stacked flap technique are the most common options. This study reports the first series of the stacked lateral thigh perforator flap. A retrospective review of all stacked lateral thigh perforator flaps done by a single group of surgeons was performed. Demographics, flap weights, complications, indications, and surgical technique were tabulated for each patient. Eight female patients with a history of breast cancer underwent delayed unilateral breast reconstruction with stacked lateral thigh perforator flaps for a total of 16 flaps. Mean patient age, body mass index, flap weight, and stacked flap weight were 47.3 years, 26.2 kg/m, 333.1 g, and 666.1 g, respectively. Microsurgical revascularization was completed in anterograde and retrograde fashion to the internal mammary vasculature. Flap survival was 100 percent and one subsequent flap revision was performed. Two patients developed a seroma at the donor site. Indications included insufficient abdominal tissue, prominent lateral thigh lipodystrophy, prior abdominal surgery, and failed prior abdominally based autologous reconstruction. This series demonstrates that the lateral thigh perforator flap is a reliable and effective option for a stacked breast reconstruction. Its ease of harvest (stemming from reliable anatomy), straightforward dissection, and intraoperative positioning make it an appealing flap option. The stacked lateral thigh perforator flap allows the reconstructive surgeon to tailor breast reconstruction to the patient, focusing on body habitus and minimizing morbidity. Therapeutic, IV.

Surgical Algorithmic Approach to Facilitate Primary Closure of the Anterolateral Thigh Flap Donor Site in Head and Neck Reconstruction.

Use of the anterolateral thigh (ALT) flap has gained popularity in head and neck reconstruction. However, donor sites that cannot achieve primary closure are reported to have poorer functional and aesthetic outcomes. Therefore, we propose an algorithm to facilitate primary closure of the donor site. Since May 2013, when an attempt at donor site direct closure failed, we have used a VY advancement flap or a propeller flap for primary closure of the donor site, using the remnant lateral thigh perforator or nearby medial thigh perforator. Otherwise, a skin graft was used. A total of 91 patients were enrolled in this algorithmic approach. We retrospectively reviewed patients with head and neck cancer who underwent cancer ablation and immediate ALT flap reconstruction since August 2010. The patients were then categorized into a "before" group and an "after" group according to the application time of the algorithm. Their demographics, intraoperative findings, and postoperative outcomes were analyzed. A total of 321 patients (309 men, 12 women) were enrolled, with 230 patients in the before group and 91 patients in the after group, with a mean age of 52.9 years. The mean size of the flap was 130 cm, with a mean width of 8.1 cm. No statistical difference existed between the groups. The donor site was directly closed in 82 patients (35.7%) in the before group. Using the perforator-based flap in 21 patients (23.1%), the donor site was closed primarily in 72 patients (79.1%) in the after group, contributing to a significantly higher donor site closure rate (P < 0.001). The average operative time was 348.7 minutes. The overall flap survival rate was 97.2%, donor-site complication rate was 6.9%, and hospitalization length was 23.5 days. None showed statistical differences between the groups. The proposed algorithm may considerably increase the primary closure rate of the ALT flap donor site.

The Lateral Thigh Perforator Propeller Flap

The Lateral Thigh Perforator Propeller Flap

The Lateral Thigh Perforator Flap for Autologous Breast Reconstruction: A Prospective Analysis of 138 Flaps

The septocutaneous tensor fasciae latae or lateral thigh perforator flap was previously introduced by the authors' group as an alternative flap for autologous breast reconstruction when the abdomen is not suitable as a donor site. The authors analyzed their experience with the lateral thigh perforator flap and present the surgical refinements that were introduced. A prospective study was conducted of all lateral thigh perforator flap breast reconstructions performed since September of 2012. Patient demographics, operative details, complications, and flap reexplorations were recorded. Preoperative imaging with magnetic resonance angiography was performed in all patients. Surgical refinements introduced during this study included limitation of the flap width and the use of quilting sutures at the donor site. A total of 138 lateral thigh perforator flap breast reconstructions were performed in 86 consecutive patients. Median operative times were 277 minutes (range, 196 to 561 minutes) for unilateral procedures and 451 minutes (range, 335 to 710 minutes) for bilateral. Median flap weight was 348 g (range, 175 to 814 g). Two total flap losses (1.4 percent) were recorded, and 11 flaps (8.0 percent) required reexploration, which resulted in viable flaps. The incidence of donor-site complications was reduced significantly after the surgical refinements were introduced. Wound problems decreased from 40.0 percent to 6.3 percent, seroma decreased from 25.0 percent to 9.5 percent, and infection decreased from 27.5 percent to 9.5 percent. The lateral thigh perforator flap is an excellent option for autologous breast reconstruction, with minimal recipient-site complications. The surgical refinements resulted in a significant reduction of donor-site complications. Therefore, the lateral thigh perforator flap is currently the authors' second choice after the deep inferior epigastric artery perforator flap. Therapeutic, IV.

Lower Extremity Free Flaps for Breast Reconstruction.

Thigh-based flaps are typically a secondary option for breast reconstruction because of concerns regarding limited tissue volume and donor-site morbidity. In recent years, there have been a number of new techniques and insights that have resulted in greater flexibility and improved outcomes. This article reviews lessons learned from a large collective experience using the following 4 flaps: transverse upper gracilis also known as transverse myocutaneous gracilis, diagonal upper gracilis, profunda artery perforator, and lateral thigh perforator flaps. Flap selection considerations include the patient's fat distribution and skin laxity, perforator anatomy, and scar location. Pearls to minimize donor-site morbidity include avoiding major lymphatic collectors in the femoral triangle and along the greater saphenous vein and respecting the limits of flap dimension to reduce wound healing complications and distal ischemia. Limited flap volume may be addressed with stacking another flap from the contralateral thigh or primary fat grafting as opposed to overaggressive flap harvest from a single thigh. A detailed review of the benefits and disadvantages of each flap and strategies to improve results is discussed. With careful planning and selection, thigh-based flaps can provide a reliable option patients desiring autologous breast reconstruction.

Comparing the sensation of common donor site regions for autologous breast reconstruction to that of a healthy breast

Autologous breast reconstruction has become the standard care for breast cancer patients. Although excellent cosmetic results can be achieved, most reconstructed breasts fail to regain normal sensation. Nerve coaptation of the flap has been suggested to improve sensation; the effect of the donor flap native sensory threshold on the degree of sensory restoration is yet to be determined. The aim of this study is to evaluate the differences in sensation between various potential donor site regions in comparison to the sensation of the healthy breast. A cross-sectional study in healthy women was performed in the Maastricht University Medical Centre. Monofilaments were used to measure sensation in the breast and at different flap donor sites: deep inferior epigastric perforator (DIEP), lateral thigh perforator (LTP), profunda artery perforator (PAP), superior gluteal artery perforator (SGAP) and transverse musculocutaneous gracilis (TMG) flaps. The Wilcoxon signed rank test was used to analyse statistical significance in sensation. Fifty women with a mean age of 49 ± 2.72 years and mean BMI of 26.14 ± 0.89 kg/m2 were included in the study. The median monofilament value of the normal breasts was 2.97(2.56-3.55). The median monofilament value of each donor site and p value when compared to the healthy breast were as follows: DIEP flap, 2.62 (2.36-3.22) p < 0.01; LTP flap, 3.61 (2.83-4.08) p <0.01; PAP flap, 3.09 (2.67-3.5) p = 0.97; SGAP flap, 3.22 (2.64-3.87) p = 0.01; and TMG flap, 3.03 (2.6-3.47) p = 0.69. There is a significant difference in sensation between the various donor site regions for breast reconstruction and the healthy breast. This may be taken into consideration for donor site selection.

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

Lateral thigh perforator flap for breast reconstruction: Computed tomographic angiography analysis and clinical series

Although abdominal-based flaps remain the first choice for autologous breast reconstruction, alternative donor sites are necessary when the abdomen is unavailable. Abdominal donor site suitability is determined, at times, according to deep inferior epigastric perforator (DIEP)-protocol computed tomographic angiography (CTA) results. CTA provides information about the pelvis/upper thigh that can be used to evaluate the suitability of other donor sites. This study aimed to examine the utility of DIEP-protocol CTA in the assessment of a lateral thigh perforator (LTP) flap. Furthermore, a small clinical LTP flap breast reconstruction series was presented. The LTP flap anatomy was studied in 100 DIEP-protocol CT angiographies (200 thighs). Collected data included lateral circumflex femoral artery (LCFA) origin; number, type, and course of LTPs; pedicle characteristics; and reference point measurements. Relative relationships between reference point anatomy and perforator anatomy were analyzed. Perforators originated from the LCFA ascending branch (4.6mm average diameter), averaging 2.6 perforators/thigh. The mean estimated pedicle length was 7.7cm (±0.7cm). Septocutaneous perforators were present in 97% (1.8 perforators/thigh). Musculocutaneous perforators were present in 64% (0.9 perforators/thigh). The mean distance between anterior superior iliac spine and perforator was 9.9cm (±1.5cm). Perforators were located 0.13cm (±1.1cm) below the pubic symphysis. Our LTP flap clinical series featured dissection in the supine position and primary donor site closure and highlighted the difficulty in flap design (six patients, nine LTP flaps). LTPs are consistent, reliably present, and radiographically appear to be suitable for microsurgical transfer. DIEP-protocol CTA is an acceptable method for imaging the pertinent LTP anatomy.

Medial sural artery perforator flap for postsurgical reconstruction of head and neck cancer.

This article aims to describe the application of medial sural artery perforator flaps (MSAPs) in reconstruction of defects following ablation of head and neck cancer. The study included 24 patients (10 males and 14 females). A total of 24 MSAPs were harvested to reconstruct defects caused by the dissection of malignant tumors of the oral and maxillofacial regions. Overall, 20 radial forearm free flaps (RFFs) and 16 anterior lateral thigh perforator flaps (ALTPs) were included in the donor site cosmetic assessments. Visual analog scale (VAS) score was used to assess postoperative oral function and cosmetic results. A total of 22 (92%) flaps healed without venous insufficiency. The external diameter of the medial sural artery for anastomosis was 2.2 mm (range, 1.3-2.5 mm), and the external diameter of the venae comitantes was 2.6 mm (range, 1.5-3.5 mm). Esthetic satisfaction with the primary site had a VAS score of 6.38 ± 1.89, while the donor site had a score of 7.34 ± 1.28. Use of MSAP and ALTP showed significantly higher esthetic satisfaction at the donor site than with RFF (p < 0.001 and p < 0.05, respectively). MSAPs show a strong advantage for donor site esthetic outcome and can be a good choice for the repair of defects of the maxillofacial area after cancer ablation.

Using the Descending Branch of the Lateral Circumflex Femoral Artery and Vein as Recipient Vessel for Free Tissue Transfer to the Difficult Areas of the Lower Extremity

Free tissue transfer to the areas around the knee or hip can be difficult because there are limited options for reliable recipient vessels, but extended vein grafts may decrease the chance for success. The purpose of this study was to describe our experience with creating a proper recipient vessel for free flap reconstructions in these areas using the descending branch of the lateral circumflex femoral vessels in the thigh. Two patients underwent free flap reconstruction of a complex knee wound after orthopedic trauma and a complex hip wound after arthroplasty. A contralateral anterior lateral thigh perforator flap and a latissimus dorsi flap were used to close the wounds, respectively. Dissection was carried between the rectus femoris and vastus lateralis and a recipient vessel was created and placed in more desirable location adjacent to the defect for microvascular anastomoses. A long 12-cm recipient vessel measuring 1.5 to 2.5 cm in diameter for both artery and vein was dissected and placed in an area adjacent to the defect for a straightforward microvascular microanastomosis. Both patients had successful free tissue reconstructions with uneventful postoperative recoveries. The flaps remained viable and the wounds healed with follow-up, revealing reliable soft tissue and good contour in the reconstructed areas. The descending branch of the lateral circumflex femoral vessels can be dissected out and serve as a recipient vessel after being placed adjacent to the defect for free tissue transfer to the difficult areas of the lower extremity. Creation of such a recipient vessel would avoid using vein grafts and ease free flap reconstruction to those difficult reconstructive areas.

The applied anatomic study on lateral thigh perforator flap

Objective To provide anatomic evidence for the application of the lateral thigh perforator flap.Methods Dissected five fresh Chinese adult lower limbs specimens which were injected with red latex via arterial cannula.On the lateral area of middle and distal thigh,obseved the number,distribution,course,category,length of pedicle and external diameter of the flaps' perforators on specimens.Results On the lateral area of middle and distal thigh 19 perforator arteris were observed in these specimens,averagely there were (3.8 ± 1.3) cutaneous perforators in each flap.Perforators mainly origined from the third perforator artery of profunda femoris,secondly from the second,fourth perforator artery and superior lateral genicular artery.Cutaneous perforators of the third perforator artery of profunda femoris pierced the flap on (13.8 ± 1.5) cm proximal of the fibulae capitulum,while the cutaneous perforators of superior lateral genicular artery on (8.6 ± 1.3) cm proximal of the fibulae capitulum.Averagely internal diameter of cutaneous perforators was (0.7 ± 0.2) mm at the point where the perforators pierced deep fascia.The diameter of the profunda femoris was (1.9 ± 0.2) mm,and the pedicle length was (12.2 ± 0.6)cm.The diameter of superior lateral genicular artery was (1.5 ± 0.2)mm,and the pedicle length was (6.8 ± 1.1) cm.There were inosculated branch in these perforators which came from profunda femoris and superior lateral genicular artery.Conclusion The anatomic characteristic allowed this flap would likely be clinically useful in repairing soft tissue defects in extremity limbs as a free or pedicled flap,which the cutaneous perforators invariably appeared on the skin of lateral areat of middle and distal thigh ; the flap could obtain enough length of the pedicle from its origination ; the vessel has large caliber supporting a substantial cutaneous territory. Key words: Profunda femoris; Superior lateral genicular artery; Perforator flap; Applied anatomy