Application of deep femoral artery third perforating artery flap for reconstruction of soft tissue defect in lower limles / 中华显微外科杂志

Objective To investigate the feasibility and clinical effects of deep femoral artery third perforating artery perforator flap for reconstruction of soft tissue defect in lower limbs.Methods From September,2008 to October,2016,8 cases of soft tissue defect in lower limbs which were repaired by deep femoral artery third perforating artery perforator flap,including 4 cases of traffic accident trauma,2 cases of chronic ulcer,1 case of a fall injury,1 case of the scar after fracture operation.The area of wounds was 8.0 cm×7.0 cm-19.0 cm×8.0 cm.Seven patients were accompanied by different degrees of infections.The deep femoral artery third perforating artery perforator flap was designed to repair,including 5 cases of pedicled flaps and 3 cases of free flaps.The flap's appearance,color,texture,infection recurrence and the recovery of lower limb function were recorded at 1,3,6,9 and 12 months followed-up.Results One flap suffered partial necrosis due to cross-zone backflow disorder,the ipsilateral medial sural artery pedicled perforator flap was used to repair.The rest of the flaps survived successfully.Skin graft was used to close the donor site in 1 case,and other donor sites were closed directly.All patients had no postoperative hematoma or secondary infection.The followed-up periods ranged from 2 to 28 months (mean,8.1 months).All flaps had satisfied appearance and texture.There were no complications such as paresthesia and numbness in the donor sites.And no motion limitations in hip and knee joint of the operated leg.Conclusion Deep femoral artery third perforating artery perforator flap can be used for both free flaps and pedicled flaps,which is a feasible method to repair soft tissue defect in lower limbs.

Anatomy of the septal perforating arteries of the heart / 대한해부학회지

The septal perforating arteries of the heart usually branch off from the anterior and inferior interventricular arteries and supply the interventricular septum and the conduction system therein. Since the septal perforating arteries are not directly visible from the outside of the heart, their anatomy and variations might be overlooked. However, the septal perforating arteries have their unique anatomy that needs to be recognized to avoid the damage of the vessels especially during common cardiac procedures such as the coronary artery bypass graft, percutaneous coronary intervention, and aortic valve replacement. A better understanding of these important arteries will help physicians to enhance the overall cardiac care for their patients. Therefore, this article discusses the anatomy, the relationship to the conduction system of the heart and the clinical significance of the septal perforating arteries.

A clinical study of perforating artery occlusion occurring after stent implantation of intracranial branch of vertebral artery / 天津医药

Objective To explore the methods to reduce the occlusion of perforating arteries after intracranial stenting of the vertebral artery. Methods Clinical data of 32 cases of Gateway-Wingspan stent implantation for intracranial branch of vertebral artery were retrospectively analyzed. The postoperative stricture and perfusion improvement situation were evaluated, the reason of perforating artery occlusion was analyzed. Results Thirty-two patients were implanted with 33 pieces of Wingspan stent and 1 piece of Apollo bracket. The operation success rate were 100%, and the stenosis rate reduced from (76.6±6.1)%to (27.9±5.2)%. After three months, the transcranial doppler sonography (TCD) and CT angiography were checked, showing no in-stent restenosis in all patients. Two patients occurred the perforating artery occlusion within 24 hours after operation. The possible reason was the change of stability of atherosclerotic plaque at the stenosis and the plaque displacement caused by the mechanical action of the balloon or stent, which may lead to medulla oblongata artery block. After drug and rehabilitation treatment, the symptoms in patients were improved significantly. Conclusion The perforating artery occlusion after stent implantation in intracranial branch of vertebral artery can be prevented by strict evaluation and preoperative preparation, the right selection of intraoperative balloon and stent, which still needs larger sample data to prove.

Anatomy study and clinical applications of complex tissue flap pedicled with inferior gluteal artery perforator for repairing giant sacrococcygeal pressure sore / 中华显微外科杂志

Objective To discuss the technical feasibility and clinical effectiveness of using complex tissue flap pedicled with inferior gluteal artery perforator for repair giant sacrococcygeal pressure sore.Methods Thirty embalmed lower limbs of adult cadavers perfused with red latex were used for anatomical study,and the followings were observed:①The course,branche and distribution of gluteal artery.②The course and distribution of the posterior femoral cutaneous nerve.③Anastomosis between the posterior cutaneous branch of gluteal artery and nutrient vessels of the posterior femoral cutaneous nerve.8 cases aging from 17 years to 56 years were completed during May 2007 to July 2013,6 cases were males and 2 cases were females.The sizes of pressure sore with the depth to Ⅳ degree were ranged from 16 cm × 9 cm to 22 cm × 10 cm.The sizes of flaps were harvested from 32 cm × 10 cm to 25 cm × 9 cm.Results The gluteal artery crossed the edge of the piriformis,the main stem was (3.1 ± 0.4) mm in diameter and gave out 2-5 muscular branches to supply the gluteus maximus.The posterior femoral cutaneous nerve crossed the edge of gluteus maximus and descended between biceps femoris and semitendinosus.Perforating deep fascia point located was (5.9 ± 0.8) cm above the line between medial and lateral femoral epicondyle.The constant anastomosis were formed by the posterior cutaneous branch of gluteal artery,the obturator artery perforator and the direct popliteal artery perforator around the posterior femoral cutaneous nerve.The complex flap survived successfully in all patients.Sutures were removed at 14 days postoperatively and the wounds healed well.All supplied areas were closed by directly suturing.Recurrent sacrococcygeal pressure sore was not observed in all cases with satisfied appearance and normal color during the outpatient follow-up period from 5 months to 5 years.Conclusion The united flap of gluteal myocutaneous flap and the posterior femoral cutaneous neurovascular flap pedicled with inferior gluteal artery perforator can be used to primary repair giant sacrococcygeal pressure sore.Rich blood supply,simple operation technique and high rate survival rate was considered as advantages of the flap.The lower recurrence of pressure sore was due to nice wear resisting with rich layer of anatomical structure in the flap and strong ability of anti-infection.The clinical effect was satisfied.

Anatomic study and clinical application of perforator free flap in posterior region of thigh / 中华显微外科杂志

Objective To study how design and harvest perforating artery free flaps in posterior region of thigh based on research of the anatomical features and distribution regularities of those perforating artery.Methods Using 8 fresh bodies specimen with latex leaded perfusion of inferior gluteal area to study perforator artery anatomy structure and distribution of rear thigh.Screen the fitting perforator arteries for perforator free flap both in caliber and length.Total 7 cases were performed with perforator free flap in posterior thigh,the flap size:from 3 cm × 8 cm-8 cm × 16 cm,and the first perforating artery flap carried out in 4 cases,the second perforating artery flap in 2 cases,the third perforating artery flap in Ⅰ case.Results Anatomic study showed that perforating artery suitable for free flap in this area were in teams of 4 to 5,the average diameter were in range of 0.4 to 2.8 mm,the average length was 2.2-9.0 cm.Seven cases had been applied with perforator flap and all survived.Followed-up from 5 to 11 months,the wounds repaired by the perforator flap of posterior thigh presented fine elasticity,thin flap,beautiful appearance.Conclusion The distribution,length and diameter of perforating artery in posterior region of thigh are suitable for perforator free flap.Being hidden,direct close the posterior region of thigh expected to acchive satisfactory clinical effects.

A Renal Perforating Artery Mistaken for Arterial Bleeding after Percutaneous Renal Biopsy: A Case Report

Perirenal hematoma after a renal biopsy is a common complication that usually resolves spontaneously, but this rarely requires transfusions or surgical/radiological intervention. We report here on a case of a renal perforating artery that was mistaken for renal arterial bleeding in a 53-year-old woman who was complicated with perirenal hematoma after undergoing a percutaneous renal biopsy. On the color and pulsed wave Doppler ultrasonography, linear blood flow was seen in the perirenal hematoma, which extended perpendicularly from the renal parenchyma into the perirenal space, and this linear blood flow exhibited an arterial pulse wave. On CT angiography, the renal perforating artery was demonstrated as a curvilinear vessel coursing tangentially to the renal margin and we decided that it was a pseudolesion caused by the renal perforating artery. A renal perforating artery may be mistaken for renal arterial bleeding after a percutaneous renal biopsy. A renal perforating artery and arterial bleeding can be differentiated by the location and shape seen on a color Doppler examination and the pulse waves characteristics.

The Regional Anatomy of Perforating artery and Pedicle for the Anterolateral Thigh Free Flap in the Korean

PURPOSE: The anterolateral thigh flap has many advantages over other conventional free flaps. But the anterolateral thigh flap has yet to enter widespread use because perforating arteries exhibit a wide range of anatomic variations and are difficult to dissect when small. The aim of this study is to identify the vascular variability of perforating arteries and pedicle in the anterolateral thigh free flap. METHODS: We studied 12 cadavers and dissected 23 thighs. An anterolateral thigh flap (12x12cm) was designed and centered at the midpoint of the line drawn from anterior superior iliac spine to the superolateral border of the patella. After we identifed the perforating arteries we dissected up to their origin from lateral circumflex femoral artery along descending branch of lateral circumflex femoral artery. We then investigated the number and the position of perforating arteries, length and diameter of vascular pedicle and pattern of lateral circumflex femoral arterial system. RESULTS: On average 2.3+/-1.1 perforating arteries per thigh were identified. The musculocutaneous perforators were 63.1%. In those perforators five perforators were arose from transverse branch of lateral circumflex femoral artery and two were arose from rectus femoral artery. Most of the perforators were near the intermuscular septum between rectus femoris muscle and vastus lateralis muscle. The length and diameter of pedicle were 11.9+/-3.5cm and 3.1+/-0.8mm on average. CONCLUSION: This study will be helpful for the success in anterolateral thigh free flap.

Anterolateral thigh flap for head and neck reconstruction : anatomic study

Microsurgical Anatomy of the Basilar Artery: Surgical Approaches to the Basilar Trunk and Vertebrobasilar Junction Aneurysms / 대한뇌혈관학회지

The success of treating basilar aneurysms lies in the preservation of all perforating arteries and best selection of the surgical approaches. The purpose of this study was to define the microsurgical anatomy of the basilar artery and surgical approaches to the basilar artery. The microsurgical anatomy of the basilar artery and its branches were evaluated in adult cadaveric brains using 3x to 20x magnification. The branches of the basilar artery can be divided into three main groups: the cerebellar, lateral pontine, and perforating arteries. The lateral pontine arteries arise from the basilar trunk and course laterally to the brachium pontis. The perforating arteries originated from the basilar trunk and penetrating near the midline of the pons on its basal surface. The basilar trunk was approached via subtemporal-transtentorial, anterior transpetrosal, posterior transpetrosal and transchondylar routes. Selection of approach for basilar aneurysms was discussed.