ANATOMIC STUDY ON PERFORATING BRANCH FLAP OF MEDIAL VASTUS MUSCLE AND ITS CLINICAL APPLICATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Yongqiang ¹ , LIANG Xiaoqin ² , WANG Jianli ¹ , WANG Chengqi ¹ , GUO Deliang ¹ , WANG Changde ¹ , CUI Lei ¹

1Department of Orthopaedics, 89th Hospital of Chinese PLA, Weifang Shandong, 261041, P.R.China;;
2Institute of Plastic Surgery, Weifang Medical College. Corresponding author: GUO Yongqiang, E-mail: gogogyq@126.com;

Corresponding author：

Keywords：

Perforating branch flap of medial vastus muscle; Anatomic study; Soft tissue defect; Wound repair

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ObjectiveTo investigate the anatomic features of the perforating branch flap of the medial vastus muscle, so as to provide a new perforating branch flap for repairing the soft tissue defect. MethodsSix fresh donated lower limb specimens underwent an intra-arterial injection of a lead oxide and lactoprene preparation. The integument of the thigh was dissected to observe the origin, course, size, and location of the perforating branch of the medial vastus muscle by angiography and photography. Based on the anatomic study, the free perforating branch flaps of the medial vastus muscle (14 cm × 6 cm to 20 cm × 5 cm) were used to repair skin and soft tissue defects (8 cm × 6 cm to 12 cm × 8 cm) of the feet in 4 patients between June 2009 and August 2011. ResultsThe artery of the medial vastus was sent out constantly from the femoral artery, and then descended in the vastus muscle to lateral patella where it anastomosed with the terminal branches of lateral femoral circumflex artery to form prepatellar vascular network. The artery of the medial vastus sent out 3-5 musculocutaneous perforating branches into the deep fascia and then extended superficially to the overlying skin. Four flaps survived after surgery; wounds at the donor site and recipient site healed by first intention. After follow-up of 6-12 months, the flaps had good appearance and texture. All ankles had normal movement range of plantarflexion and dorsiflexion. ConclusionThe free perforating branch flaps of the medial vastus muscle can be harvested easily, and have the advantage of good texture and abundant donor site.

Citation： GUO Yongqiang,LIANG Xiaoqin,WANG Jianli,WANG Chengqi,GUO Deliang,WANG Changde,CUI Lei. ANATOMIC STUDY ON PERFORATING BRANCH FLAP OF MEDIAL VASTUS MUSCLE AND ITS CLINICAL APPLICATION. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(9): 1091-1094. doi: Copy

1.	徐达传, 张世民, 唐茂林, 等. 穿支皮瓣的发展与现状. 中国修复重建外科杂志, 2011, 25(9): 1025-1029.
2.	吴学强, 刘会仁, 刘德群. 股前外侧皮瓣应用研究的进展. 中华显微外科杂志, 2011, 34(1): 83-85.
3.	Hanasono M, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg, 2010, 125(1): 209-214.
4.	杨晓东, 丁茂超, 梅劲, 等. 股前内侧穿支皮瓣的应用解剖学研究. 中国临床解剖学杂志, 2011, 29(6): 624-628.
5.	Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg, 1987, 40(2): 113-141.
6.	Cormack GC, Lamberty BG. A classification of fascio-cutaneous flaps according to their patterns of vascularisation. Br J Plast Surg, 1984, 37 (1): 80-87.
7.	Rozen WM, Grinsell D, Koshima I, et al. Dominance between angiosome and perforator territories: a new anatomical model for the design of perforator flaps. J Reconstr Microsurg, 2010, 26(8): 539-545.
8.	Cotrufo S, Dabernig J, Russell D, et al. The vascular anatomy of the rat superficial epigastric flap by vascular corrosion casting and technical refinement for the study of choke vessels in cadaveric flap models. Ann Plast Surg, 2010, 64(1): 93-97.
9.	Sinna R, Boloorchi A, Mahajan AL, et al. What should define a “perforator flap”? Plast Reconstr Surg, 2010, 126(6): 2258-2263.
10.	Blondeel PN, Van Landuyt KH, Monstrey SJ, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg, 2003, 112(5): 1378-1387.
11.	张世民, 唐茂林, 穆广态, 等. 穿支皮瓣及相关术语的专家共识. 中国临床解剖学杂志, 2010, 28(5): 475-477.
12.	Pan WR, Taylor GI. The angiosomes of the thigh and buttock. Plast Reconstr Surg, 2009, 123(1): 236-249.
13.	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.
14.	Koshima I, Hosoda M, Inagawa K, et al. Free medial thigh perforator-based flaps: new definition of the pedicle vessels and versatile application. Ann Plast Surg, 1996, 37(5): 507-515.
15.	Yu P, Selber J. Perforator patterns of the anteromedial thigh flap. Plast Reconstr Surg, 2011, 128(3): 151e-157e.
16.	Xu ZF, Sun CF, Duan WY, et al. Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck. Br J Oral Maxillofac Surg, 2011. [Epub ahead of print].
17.	Hong JP, Kim EK, Kim H, et al. Alternative regional flaps when anterolateral thigh flap perforator is not feasible. J Hand Microsurg, 2010, 2(2): 51-57.
18.	Kim JT, Kim CY, Kim YH. T-anastomosis in microsurgical free flapreconstruction: an overview of clinical applications. J Plast Reconstr Aesth Surg, 2008, 61(10): 1157-1163.
19.	Koshima I, Fujitsu M, Ushio S, et al. Flow-through anterior thigh flaps with a short pedicle for reconstruction of lower leg and foot defects. Plast Reconstr Surg, 2005, 115(1): 155-162.
20.	Hallock GG. The complete nomenclature for combined perforator flaps. Plast Reconstr Surg, 2011, 127(4): 1720-1729.

1. 徐达传, 张世民, 唐茂林, 等. 穿支皮瓣的发展与现状. 中国修复重建外科杂志, 2011, 25(9): 1025-1029.
2. 吴学强, 刘会仁, 刘德群. 股前外侧皮瓣应用研究的进展. 中华显微外科杂志, 2011, 34(1): 83-85.
3. Hanasono M, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg, 2010, 125(1): 209-214.
4. 杨晓东, 丁茂超, 梅劲, 等. 股前内侧穿支皮瓣的应用解剖学研究. 中国临床解剖学杂志, 2011, 29(6): 624-628.
5. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg, 1987, 40(2): 113-141.
6. Cormack GC, Lamberty BG. A classification of fascio-cutaneous flaps according to their patterns of vascularisation. Br J Plast Surg, 1984, 37 (1): 80-87.
7. Rozen WM, Grinsell D, Koshima I, et al. Dominance between angiosome and perforator territories: a new anatomical model for the design of perforator flaps. J Reconstr Microsurg, 2010, 26(8): 539-545.
8. Cotrufo S, Dabernig J, Russell D, et al. The vascular anatomy of the rat superficial epigastric flap by vascular corrosion casting and technical refinement for the study of choke vessels in cadaveric flap models. Ann Plast Surg, 2010, 64(1): 93-97.
9. Sinna R, Boloorchi A, Mahajan AL, et al. What should define a “perforator flap”? Plast Reconstr Surg, 2010, 126(6): 2258-2263.
10. Blondeel PN, Van Landuyt KH, Monstrey SJ, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg, 2003, 112(5): 1378-1387.
11. 张世民, 唐茂林, 穆广态, 等. 穿支皮瓣及相关术语的专家共识. 中国临床解剖学杂志, 2010, 28(5): 475-477.
12. Pan WR, Taylor GI. The angiosomes of the thigh and buttock. Plast Reconstr Surg, 2009, 123(1): 236-249.
13. 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.
14. Koshima I, Hosoda M, Inagawa K, et al. Free medial thigh perforator-based flaps: new definition of the pedicle vessels and versatile application. Ann Plast Surg, 1996, 37(5): 507-515.
15. Yu P, Selber J. Perforator patterns of the anteromedial thigh flap. Plast Reconstr Surg, 2011, 128(3): 151e-157e.
16. Xu ZF, Sun CF, Duan WY, et al. Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck. Br J Oral Maxillofac Surg, 2011. [Epub ahead of print].
17. Hong JP, Kim EK, Kim H, et al. Alternative regional flaps when anterolateral thigh flap perforator is not feasible. J Hand Microsurg, 2010, 2(2): 51-57.
18. Kim JT, Kim CY, Kim YH. T-anastomosis in microsurgical free flapreconstruction: an overview of clinical applications. J Plast Reconstr Aesth Surg, 2008, 61(10): 1157-1163.
19. Koshima I, Fujitsu M, Ushio S, et al. Flow-through anterior thigh flaps with a short pedicle for reconstruction of lower leg and foot defects. Plast Reconstr Surg, 2005, 115(1): 155-162.
20. Hallock GG. The complete nomenclature for combined perforator flaps. Plast Reconstr Surg, 2011, 127(4): 1720-1729.

Chinese Journal of Reparative and Reconstructive Surgery

ANATOMIC STUDY ON PERFORATING BRANCH FLAP OF MEDIAL VASTUS MUSCLE AND ITS CLINICAL APPLICATION

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