Objective To provide the anatomical basis for posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator. Methods A total of 30 embalmed lower limbs of adult cadavers perfused with red latex were dissected and measured to observe the course and distribution of posterior femoral cutaneous nerve (PFCN), and the anastomoses between direct popliteal artery perforator and nutrient vessels of PFCN. Mimic operation was performed on 1 side of fresh specimen. Results PFCN started from the midpoint of the inferior gluteus maximus edge, and went down along the middle line of posterior thigh region, and the final trunk of PFCN accompanied with small saphenous vein down to the middle line of lower leg. The diameters of PFCN was (3.0 ± 0.6) mm at the inferior gluteus maximus edge, and was (2.0 ± 0.7) mm at the superior fossa poplitea. The nutrient vessels of PFCN were multi-segmental and polyphyletic. The direct popliteal artery perforator which started from popliteal artery directly was constant pierced into deep fascia about 7-11 cm above the knee joint, and its original diameter was (0.8 ± 0.2) mm. The direct popliteal artery perforator had 1-2 accompanying veins, and this perforator artery was the main nutrient vessel of the inferior segment of PFCN. The direct popliteal artery perforator gave off 5-8 small vessels which anastomosed with the 1st-3rd perforator of deep femoral artery, the obturator artery perforator, and the lateral femoral circumflex artery perforators. Then these nutrient vessels formed vascular plexus along PFCN in the middle line of posterior region of thigh. Mimic operation showed that the posterior femoral neurocutaneous vascular flap pedicled with direct poplitea artery perforator could be formed successfully. Conclusion The posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator has constant blood supply and can be easily formed to repair defects around knee joint.
Teh transposition of the first cuneiform bone with the anterior medial malleolar artery peidcel had been utilized successfully. It provided a new donor bone for repairing talus neck fracture. necrosis of the talus body and for fusing the joints of the ankle and foot. The position of the artery was comparatively constant, sothat the bone flap could be easily accessible. The operations was simple and easily performed.
ObjectiveTo investigate the effectiveness of using radial mid-forearm perforator fasciocutaneous flap to repair soft tissue defect in lower segment of the forearm and the wrist. MethodsBetween May 2007 and July 2012, 7 cases of soft tissue defect of lower segment of the forearm and the wrist were repaired with radial mid-forearm perforator fasciocutaneous flap. There were 6 males and 1 female with an average age of 38 years (range, 22-45 years). Defects were caused by crushing injury in 4 cases with the disease duration of 3-22 days (mean, 14 days), by internal fixation of ulnar comminuted fracture in 2 cases after 16 and 20 days of operation respectively, and by focal cleaning of wrist joint tuberculosis in 1 cases after 24 days of operation. The locations of defect were the lower segment of the forearm in 5 cases and the dorsal side of the wrist in 2 cases. The area of soft tissue defect ranged from 4 cm×3 cm to 9 cm×5 cm. The size of flap ranged from 6 cm×4 cm to 12 cm×6 cm. The donor site was closed with direct suturing or skin grafting. ResultsThe intraoperative blood loss was 50-90 mL (mean, 64 mL); the operation time was 60-80 minutes (mean, 72 minutes). Six flaps survived with wound heal ing by first intention; partial flap necrosis occurred in 1 case, and delayed healing was obtained after dressing change. Skin grafting at donor sites survived with healing of incision by first intention. The patients were followed up 3-14 months (mean, 9 months). No ulcer or sinus tract was observed; all flaps showed a sl ightly swollen appearance and had normal color. ConclusionRadial mid-forearm perforator fasciocutaneous flap does not need to dissect the source of blood vessels due to constantly anatomical structure. It has the advantages of easy operation, rich blood supply, high survival rate, and satisfactory cl inical effect, so it is an important supplement of the other non-main vessel pedicle flaps to repair soft tissue defect in the lower segment of the forearm and the wrist.