Objective To explore the feasibility and technical points of soft tissue defect reconstruction of the lower extremity using the distally based anterolateral thigh (dALT) flap based on perforating vessels from the lateral circumflex femoral artery (LCFA) oblique branch. Methods Between July 2010 and July 2016, 7 patients underwent defect reconstruction of the lower extremities using the dALT flap based on perforating vessels from the LCFA oblique branch. There were 4 males and 3 females with an average age of 26.7 years (range, 3-58 years). The etiologies included angiofibrolipoma in 1 case, malignant fibrous sarcoma in 1 case, soft tissue sarcoma in 1 case, and post-burn scar contracture in 4 cases. The disease duration was 13 years, 1 year, and 8 months in 3 patients with tumors respectively, and was from 6 months to 35 years in 4 patients with post-burn scar contracture. After resection of lesion tissues, the defect size ranged from 8 cm×6 cm to 24 cm×8 cm. The flap size ranged from 9 cm×7 cm to 24 cm×8 cm. The length of the pedicle ranged from 12 to 22 cm (mean, 16.6 cm). The distance from the flap pivot point to the superolateral border of the patella ranged from 9.5 to 14.0 cm (mean, 11.8 cm). The donor sites were directly closed in 6 cases and covered with the split-thickness skin graft in 1 case. Results All flaps survived after surgery without any major complications. All wounds at the donor and the recipient sites healed primarily. The patients were followed up from 5 to 54 months (mean, 30.7 months). The color, texture, and thickness of the flaps were similar to those of the surrounding skin. No tumor recurrence was observed. The range of motion of flexion and extension of the knee joint were greatly improved in the patients with post-burn scar contracture. Conclusion For patients who have the oblique branch from the LCFA descending branch which sends out perforating vessels to the skin of the anterolateral thigh region, a dALT flap could be used to reconstruct soft tissue defects of the lower extremities.
The hemodynamic parameters in arteries are difficult to measure non-invasively, and the analysis and prediction of hemodynamic parameters based on computational fluid dynamics (CFD) has become one of the important research hotspots in biomechanics. This article establishes 15 idealized left coronary artery bifurcation models with concomitant stenosis and aneurysm lesions, and uses CFD method to numerically simulate them, exploring the effects of left anterior descending branch (LAD) stenosis rate and curvature radius on the hemodynamics inside the aneurysm. This study compared models with different stenosis rates and curvature radii and found that as the stenosis rate increased, the oscillatory shear index (OSI) and relative residence time (RRT) showed a trend of increase; In addition, the decrease in curvature radius led to an increase in the degree of vascular curvature and an increased risk of vascular aneurysm rupture. Among them, when the stenosis rate was less than 60%, the impact of stenosis rate on aneurysm rupture was greater, and when the stenosis rate was greater than 60%, the impact of curvature radius was more significant. Based on the research results of this article, it can be concluded that by comprehensively considering the effects of stenosis rate and curvature radius on hemodynamic parameters, the risk of aneurysm rupture can be analyzed and predicted. This article uses CFD methods to deeply explore the effects of stenosis rate and curvature radius on the hemodynamics of aneurysms, providing new theoretical basis and prediction methods for the assessment of aneurysm rupture risk, which has important academic value and practical guidance significance.