Vascular anatomy and clinical application of type <b>Ⅲ</b> perforator flap based on the oblique branch of lateral circumflex femoral artery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Hui ^1,2 , CHEN Jianda ² , LUO Wenfang ² , ZHOU Xiaofan ² , HUANG Huafeng ² , XIAO Shun’e ¹ , WEI Zairong ¹ ,  DENG Chengliang ¹

1. Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;
2. Department of Orthopedics and Plastic Surgery, Third People’s Hospital of Guizhou Province, Guizhou Guiyang, 550001, P. R. China;

Corresponding author：

DENG Chengliang, Email: cheliadeng@sina.com

Keywords：

Lateral circumflex femoral artery; oblique branch; perforator flap; anatomy; soft tissue defect

DOI：

10.7507/1002-1892.202108131

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the vascular anatomy and the clinical application of type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery on skin soft tissue defect at the limbs. Methods Vascular anatomy of anterolateral thigh flap was performed on a 43-year-old male cadaver perfused with red latex, and the travel and perforating distribution of the oblique branches of lateral circumflex femoral artery were observed. A retrospective case series study was used to analyze the clinical data of 12 patients with skin soft tissue defects of the extremities admitted between January 2018 and September 2019, including 9 males and 3 females; aged from 18 to 65 years, with a median age of 32 years. The injury site included 7 cases of foot and ankle, 3 cases of calf, and 2 cases of hand. The wound size was ranged from 9 cm×7 cm to 28 cm×10 cm. The time from injury to operation was 1-2 weeks, with an average of 10 days. All patients were repaired with type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery, including 3 cases of single-leaf flap, 6 cases of double-leaf flaps, and 3 cases of tri-leaf flaps. The flap ranged from 15 cm×5 cm to 28 cm×10 cm. The donor site was directly sutured or repaired with local flap. The flap survival and complications were observed after operation. Results The results of vascular anatomy showed that the lateral femoral circumflex artery sent out transverse branches, oblique branches, and descending branches. The oblique branches sent out multiple muscle perforating branches along the way, the perforating branches passed through the anterolateral femoral muscle, and the blood supply scope was the skin of the anterolateral femoral region. The clinical results showed that all flaps survived completely and the incisions healed by first intension. There was no complication such as vascular crisis. All 12 patients were followed up 3-12 months, with an average of 7 months. The appearance and texture of the flap were good. At last follow-up, according to the British Medical Research Council (BMRC) Society for neurological trauma standard, the sensory of the flap reached S₂ in 9 cases and S₃ in 3 cases. Linear scar remained in the donor area, without pain, pruritus, tactile allergy, and other discomfort. The patients and their families were satisfied. Conclusion Type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery is a reliable method for repairing the soft tissue defect of the limbs, with reliable blood supply, large cutting area, various types of perforator flaps.

Citation： LIU Hui, CHEN Jianda, LUO Wenfang, ZHOU Xiaofan, HUANG Huafeng, XIAO Shun’e, WEI Zairong, DENG Chengliang. Vascular anatomy and clinical application of type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(1): 92-97. doi: 10.7507/1002-1892.202108131 Copy

1.	Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg, 1984, 37(2): 149-159.
2.	Xu DC, Zhong SZ, Kong JM, et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg, 1988, 82(2): 305-310.
3.	Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg, 2002, 109(7): 2219-2226.
4.	徐永清, 何晓清, 朱跃良, 等. 股前外侧皮瓣在儿童四肢创面修复中的应用. 中华创伤杂志, 2018, 34(10): 875-880.
5.	康永强, 吴永伟, 马运宏, 等. 穿支定位技术辅助股前外侧分叶穿支皮瓣移植修复前臂及手部大面积软组织缺损. 中华创伤杂志, 2018, 34(10): 886-891.
6.	Rozen WM, Ashton MW, Pan WR, et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery, 2009, 29(1): 16-23.
7.	Seth R, Manz RM, Dahan IJ, et al. Comprehensive analysis of the anterolateral thigh flap vascular anatomy. Arch Facial Plast Surg, 2011, 13(5): 347-354.
8.	Lee YC, Chen WC, Chou TM, et al. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications. Plast Reconstr Surg, 2015, 135(4): 1097-1107.
9.	Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2): 571-577.
10.	Deng C, Nie K, Wei Z, et al. Is the oblique branch a preferable vascular pedicle for anterolateral thigh free flaps? J Reconstr Microsurg, 2018, 34(7): 478-484.
11.	Deng C, Chang S, Wei Z, et al. Alternative design for anterolateral thigh multi-paddled flaps: The 3-5 system. Med Sci Monit, 2018, 24: 9102-9109.
12.	张春, 占蓓蕾, 陈土根, 等. 股前外侧皮瓣血管的临床分型及意义. 中国临床解剖学杂志, 1991, 9(2): 109-111, 128.
13.	徐达传, 阮默, 张春, 等. 股前外侧部皮瓣的进一步解剖学研究-高位皮动脉与皮瓣血供的分型. 中国临床解剖学杂志, 2002, 20(6): 410-413.
14.	Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg, 2006, 118(4): 928-933.
15.	Deng C, Wu B, Wei Z, et al. A systematic study of vascular distribution characteristics and axis design of various flap types. Med Sci Monit, 2019, 25: 721-729.
16.	da Costa AC, Penteado Lancelotti CL. Oblique branch of the lateral circumflex femoral artery also found in 32 percent of cadavers in Brazil. Plast Reconstr Surg, 2009, 124(3): 1011-1012.
17.	芮永军, 张雁, 施海峰, 等. 穿支定位技术在预防股前外侧皮瓣供区并发症中的应用. 中华显微外科杂志, 2016, 39(6): 529-533.
18.	Deng C, Li H, Wei Z, et al. Various surgical techniques to create an aesthetic appearance at the donor site of anterolateral thigh free flaps based on the oblique branch: Twenty-one clinical case reports. Medicine (Baltimore), 2018, 97(7): e9885. doi: 10.1097/MD.0000000000009885.
19.	常树森, 何春念, 金文虎. 股前外侧皮瓣的供区并发症. 中华显微外科杂志, 2018, 41(1): 101-104.
20.	Chen YC, Scaglioni MF, Carrillo Jimenez LE, et al. Suprafascial anterolateral thigh flap harvest: A better way to minimize donor-site morbidity in head and neck reconstruction. Plast Reconstr Surg, 2016, 138(3): 689-698.
21.	韩婷璐, 臧梦青, 朱珊, 等. 以旋股外侧动脉不同分支来源的穿支为蒂的螺旋桨皮瓣手术设计和临床应用. 中华整形外科杂志, 2019, 35(9): 854-861.
22.	臧梦青, 朱珊, 陈博, 等. 旋股外侧动脉斜支在带蒂股前外侧皮瓣中的应用. 中华整形外科杂志, 2019, 35(10): 995-999.

1. Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg, 1984, 37(2): 149-159.
2. Xu DC, Zhong SZ, Kong JM, et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg, 1988, 82(2): 305-310.
3. Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg, 2002, 109(7): 2219-2226.
4. 徐永清, 何晓清, 朱跃良, 等. 股前外侧皮瓣在儿童四肢创面修复中的应用. 中华创伤杂志, 2018, 34(10): 875-880.
5. 康永强, 吴永伟, 马运宏, 等. 穿支定位技术辅助股前外侧分叶穿支皮瓣移植修复前臂及手部大面积软组织缺损. 中华创伤杂志, 2018, 34(10): 886-891.
6. Rozen WM, Ashton MW, Pan WR, et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery, 2009, 29(1): 16-23.
7. Seth R, Manz RM, Dahan IJ, et al. Comprehensive analysis of the anterolateral thigh flap vascular anatomy. Arch Facial Plast Surg, 2011, 13(5): 347-354.
8. Lee YC, Chen WC, Chou TM, et al. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications. Plast Reconstr Surg, 2015, 135(4): 1097-1107.
9. Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2): 571-577.
10. Deng C, Nie K, Wei Z, et al. Is the oblique branch a preferable vascular pedicle for anterolateral thigh free flaps? J Reconstr Microsurg, 2018, 34(7): 478-484.
11. Deng C, Chang S, Wei Z, et al. Alternative design for anterolateral thigh multi-paddled flaps: The 3-5 system. Med Sci Monit, 2018, 24: 9102-9109.
12. 张春, 占蓓蕾, 陈土根, 等. 股前外侧皮瓣血管的临床分型及意义. 中国临床解剖学杂志, 1991, 9(2): 109-111, 128.
13. 徐达传, 阮默, 张春, 等. 股前外侧部皮瓣的进一步解剖学研究-高位皮动脉与皮瓣血供的分型. 中国临床解剖学杂志, 2002, 20(6): 410-413.
14. Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg, 2006, 118(4): 928-933.
15. Deng C, Wu B, Wei Z, et al. A systematic study of vascular distribution characteristics and axis design of various flap types. Med Sci Monit, 2019, 25: 721-729.
16. da Costa AC, Penteado Lancelotti CL. Oblique branch of the lateral circumflex femoral artery also found in 32 percent of cadavers in Brazil. Plast Reconstr Surg, 2009, 124(3): 1011-1012.
17. 芮永军, 张雁, 施海峰, 等. 穿支定位技术在预防股前外侧皮瓣供区并发症中的应用. 中华显微外科杂志, 2016, 39(6): 529-533.
18. Deng C, Li H, Wei Z, et al. Various surgical techniques to create an aesthetic appearance at the donor site of anterolateral thigh free flaps based on the oblique branch: Twenty-one clinical case reports. Medicine (Baltimore), 2018, 97(7): e9885. doi: 10.1097/MD.0000000000009885.
19. 常树森, 何春念, 金文虎. 股前外侧皮瓣的供区并发症. 中华显微外科杂志, 2018, 41(1): 101-104.
20. Chen YC, Scaglioni MF, Carrillo Jimenez LE, et al. Suprafascial anterolateral thigh flap harvest: A better way to minimize donor-site morbidity in head and neck reconstruction. Plast Reconstr Surg, 2016, 138(3): 689-698.
21. 韩婷璐, 臧梦青, 朱珊, 等. 以旋股外侧动脉不同分支来源的穿支为蒂的螺旋桨皮瓣手术设计和临床应用. 中华整形外科杂志, 2019, 35(9): 854-861.
22. 臧梦青, 朱珊, 陈博, 等. 旋股外侧动脉斜支在带蒂股前外侧皮瓣中的应用. 中华整形外科杂志, 2019, 35(10): 995-999.

Previous Article
Retraction notice to “Research progress of in vivo bioreactor for bone tissue engineering”
Next Article
Repair of complex wounds of limbs with free lobed perforator flaps

Chinese Journal of Reparative and Reconstructive Surgery

Vascular anatomy and clinical application of type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content