The anatomy of the lateral circumflex femoral artery in anterolateral thigh flap.

OBJECTIVE: To determine systematically the pattern of the cutaneous perforator of the lateral circumflex femoral artery (LCFA) in anterolateral thigh perforator (ALT) flap. MATERIAL AND METHOD: Sixty dissections of the LCFA were carried out in 30 preserved cadavers. The number; type, origin, and location of the cutaneous perforators of the LCFA were studied and measured. RESULTS: There were 169 perforators. In 79.3%, the perforators originated from the descending branch, 18.3% from the transverse branch. The perforator of the medial descending and the ascending branch were found in 1.8% and 0.6%, respectively. The most cutaneous perforators were concentrated in the middle third (14 to 28 cm from the ASIS) of the anterolateral thigh region. CONCLUSION: The perforator of the descending branch, which was located ranging from 21 to 35 cm, was appropriate for flap designing to avoid the perforator of the transverse branch, which was difficult to harvest.

Anatomical study of the superior gluteal artery perforator (S-GAP) for free flap harvesting.

OBJECTIVE: To present the appropriate superior gluteal branch for free flap harvesting. MATERIAL AND METHOD: The characteristic and external diameter of the pedicles and the main perforators, and length of the pedicles were studied in both sides of 30 formalin-preserved cadavers. RESULTS: The patterns of the pedicle could be classified into four types, the vertical, the horizontal, the descending, and the penetrating main branches. The descending branch was the longest (7.33 +/- 1.3 cm). While the pedicle and perforator of the horizontal branches was the largest (2.7 +/- 0.6 mm and 1.2 +/- 0.2 mm, respectively). However, it was difficult to dissect the vertical and the horizontal branches because the vessel courses did not run in the direction of the muscle fiber. Whereas the penetrating main branches were observed in the intermuscular septum so, it was easy to approach the pedicle. The length (5.3 +/- 1.3 cm) and external diameter (2.17 +/- 0.5 mm) of the pedicle were adequate for free flap harvesting. CONCLUSION: In the anatomical study the penetrating pedicle was recommended to use for the S-GAP flap.

The anatomy of the thoracodorsal artery in perforator flap for resurfacing shallow defect.

OBJECTIVE: To systematically determine the location and number of cutaneous perforators greater than 0. 5 mm in diameter of the lateral branch of the thoracodorsal artery perforator flap for resurfacing shallow defect. MATERIAL AND METHOD: Sixty dissections of the thoracodorsal arterial system were carried out in 30 preserved cadavers. The location and number of cutaneous perforators greater than 0.5 mm in diameter of the lateral branch of the thoracodorsal artery perforator flap were studied and measured. RESULTS: Seventy-six perforators were found in 60 flaps (1.3 perforators per flap). The first perforator was exited in all dissections. It emerged from the latissimus dorsi muscle 9.8 cm below the dome of the axilla. In 21.67% of the cases, the second perforator of the thoracodorsal artery arose 3.4 cm distal to the origin of the first perforator The third perforator was found in 5% of dissections, and originated 3.0 cm away from the origin of the second perforator In addition, most perforators penetrated the muscle within 7.0-14. 0 cm below the dome of the axilla. CONCLUSION: The center of the flap designed should be placed between 7 to 14 cm from the dome of the axilla.

Neurovascular anatomy of the deep inferior epigastric perforator flap for breast reconstruction.

OBJECTIVE: To find out the most suitable perforator and cutaneous nerve for strategic design of the deep inferior epigastric perforator (DIEP) flap. MATERIAL AND METHOD: The characteristics of the pedicles, perforators, intercostal nerves and the relationship between nerves and vessels in DIEP flaps were studied in 31 formalin-preserved cadavers. RESULTS: Four hundred and five perforator vessels were divided into three vertical rows. These perforators were mostly contained in the medial row (45.4%), the average size of the perforators in the lateral row was the largest (1.0+/- 0.3 mm). The largest perforators (1.4+/- 0.3 mm) were mostly located within 1 cm horizontally from the umbilicus. Lateral row perforators, usually rectilinear course (82.7%), traveled with nerves from the beginning. Whereas, the perforators in the medial row usually coursed obliquely (86.4%) and were not related to nerves initially, they joined before piercing the rectus sheath. CONCLUSION: The present findings indicate that it would be more beneficial to use the lateral row perforators.