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Objective:To investigate the removal of ALTPF pedicled with the lateral branch of the descending branch of the lateral femoral circumflex artery and its application in wound repair.Methods:From January, 2019 to March, 2021, 32 cases of limb wounds were repaired with ALTPF pedicled with the lateral branch of the descending branch of the lateral femoral circumflex artery, including 25 males and 7 females. The age ranged from 21 to 63 years, with an average of 34 years. Injury mechanism: there were 12 cases of traffic accident injury, 8 cases of machine injury, 6 cases of heavy object crushing injury and 6 cases of chronic infectious wound. The area of soft tissue defect was 8.2 cm × 6.3 cm-18.6 cm × 11.2 cm. There were 25 cases of direct suture and 7 cases of free skin grafting. All patients who needed flap repair underwent CTA and high-frequency CDU before operation to judge the approximate direction of the lateral branch of the descending branch of the lateral femoral circumflex artery and the position of the perforating branch. All patients were followed-up regularly for 3 - 13 months, with an average of 11 months.Results:All patients who underwent free flap surgery had no vascular crisis and the flap survived smoothly. At the last follow-up, the appearance of the flap was beautiful without bloating and there were no complications in the donor area.Conclusion:Compared with the traditional ALTPF, the perforator flap of the lateral branch of the descending branch of the anterolateral femoral artery is relatively simple, which can replace the traditional ALTPF to a certain extent, and is worthy of popularization and application in clinic.
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Objective@#To explore the feasibility and technical points of soft tissue defect reconstruction using the pedicled anterolateral thigh flap based on perforating vessels from the lateral circumflex femoral artery oblique branch.@*Methods@#Between November 2009 and April 2019, 27 pedicled anterolateral thigh flaps were performed to repair the wound of trunk and lower extremity, based on perforating vessels from the lateral circumflex femoral artery oblique branch. 16 flaps were proximally based and 11 were distally based.@*Results@#The proximally based flap ranged from 15 cm×8 cm to 32 cm×12 cm. The mean length of the pedicle was 8.2 cm. The distally based flap ranged from 9 cm×7 cm to 24 cm×8 cm. The mean length of the pedicle was 18.6 cm. All flaps survived after surgery. Venous congestion occurred in one flap and relieved in five days.@*Conclusions@#With oblique branch as the pedicle, the vascular dissection was easy and donor site morbidity was minimized while harvesting the proximally based anterolateral thigh flaps; long pedicle could be obtained, and the reconstructive sphere was extended when using the distally based anterolateral thigh flaps.
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Objective@#To explore the flap design and clinical applications of the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery in defect reconstruction.@*Methods@#Between September 2009 and December 2018, 27 patients with soft tissue defects from lower extremities were involved in this study, including 15 males and 12 females, with an average age of 34.6 years old (range, 3 to 73 years old). Before surgery, the type of the flap to be used was designed preliminarily by evaluating the location, size and shape of the lesion or defect. The perforators of the lateral circumflex femoral artery were explored using an ultrasound Doppler probe, marked on skin. The computed tomographic angiography was also used to get more information of the branches of the lateral circumflex femoral artery when possible. The propeller flaps were divided into typeⅠ, Ⅱ, Ⅲ, and Ⅳ according to the perforators that originated from the transverse, descending, oblique, and rectus femoris branches of the lateral circumflex femoral artery, respectively. The type Ⅱ flap was subdivided into type Ⅱa and type Ⅱb flaps that were based on antegrade and reverse flow from the descending branch. The defects were reconstructed using the perforator propeller flap.@*Results@#Twenty-seven patients underwent reconstruction of defects using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery including 3 type Ⅰ flap, 12 type Ⅱa, 2 type Ⅱb, 10 type Ⅲ and 3 type Ⅳ. The size, pedicle length and rotation angle of the flaps were 12 cm×6 cm to 30 cm×15 cm, 4 cm to 15 cm, and 60 to 180 degrees, respectively. Total necrosis occurred in one flap and small-sized distal necrosis in another one. Minor complications occurred in two flaps and the remaining propeller flaps survived completely. All patients were followed up from one to 25 months and mean follow-up time was 9.9 months. Tumor recurrence was noticed in one patient. All patients were satisfied with the final functional and aesthetic outcomes.@*Conclusions@#For appropriate cases, reconstruction of defects from the groin to the knee could be achieved by using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery, with advantages of easy-to-operate and minor donor-site morbidity.
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Objective@#To investigate the feasibility and efficacy of free lobulated lateral circumflex femoral artery perforator flap for foot and ankle defect at non-weight bearing area.@*Methods@#From January 2008 to June 2016, 28 cases with foot and ankle skin and soft tissue defects at non-weight bearing area were treated, including 16 cases with traffic accident, 8 cases with machine injury, and 4 cases with falling injury. There were 10 cases with Achilles tendon exposure, 16 cases with dorsalis pedis tendons exposure and 12 cases with bone exposure. The defect size ranged from 10 cm×8 cm to 16 cm×13 cm. Doppler ultrasound detector was used to select two perforators of lateral femoral circumflex artery. The lobulated perforator flap was designed and harvested as one flap. After clip test was performed to make sure the blood supply of flap, the flap was segmented and repositioned to cover the wound. The width of lobulated flaps was less than 8cm, in order to close the defect at donor sites directly. Postoperative rountine anti-inflammatory, anticoagulant, anticonvulsive treatment and function exercise were adopted. The patients were followed up for 6-28 months.@*Results@#The flap size ranged from 9.0 cm×4.5 cm to 17.0 cm×7.0 cm. Partial necrosis happened at the end of one flap lobe due to pressure, which healed after dressing. All the other 27 flaps survived completely with satisfactory cosmetic and functional result. The wounds at donor sites all healed primarily.@*Conclusions@#Free lobulated lateral circumflex femoral artery perforator flap is one of the ideal flaps with high survival rate and low complication for foot and ankle defect at non-weight bearing area.
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Objective To recognize the relationship between high cutantous artery branches and descending branch of lateral femoral circumflex artery artery,and to investigate the blood supply of anterolateral thigh flap in clinical.Methods Retrospective analysis 152 cases of anterolateral thigh flap from November,2003 to December,2016.It contains cutting with descending branchs in 99 cases,cutting with lateral branchs in 43 cases,the union of them in 8 cases and high cutantous artery branches in 2 cases.Results The flaps survival in 147 cases,cutting necrosis in 3 cases and partly necrosis in 2 cases.Descending and lateral branchs were both dominance neurovascular bundle of vastus lateralis muscle,independently or commonly dominate the skin of anterolateral thigh,occurrence rate was 33.5％.Conclusion The descending branch of lateral femoral circumflex artery include lateral branch,all of which are the neurovascular bundles,supply the anterolateral thigh muscle,and divid into some perforator branches crossing the musle to the anterolateral thigh skin subsequently,which constitute "the anatomical functional unit".High cutantous artery branche is the one of all of the branches,its origin lies hight and arise from lateral branch.
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Objective To summarize the individualized design of perforating branches in the KISS flap of the descending branch of lateral femoral circumflex artery and improve the survival rate of flap. Methods From September, 2012 to June, 2016, the individualized design KISS flap of perforating branches of lateral femoral circum-flex artery was used to repair the soft defect in arms and legs in 20 cases, which contained 12 males and 8 females aged from 23 to 71 years old with an average of 48 years. The wounds in upper limb and wrist were 16 cases, and in instep and lower extremity wounds were 4 cases. The areas of tissue defect were ranged from 8.5 cm ×12.0 cm to 12.0 cm×23.0 cm. The area of flap ranged from 5.0 cm×8.0 cm to 8.0 cm×14.0 cm. Donor sites were sutured directly. Post-operative follow-up was done termly. Results All flaps survived without vascular crisis. The wounds and incisions at donor sites were the primary healing. Seventeen cases were followed-up 6 to 24 months (average, 18 months). The color and texture of the flaps were good, and the appearance was satisfactory. The donor site of the flap only left linear scar. Conclusion Designed KISS flap according to diameter of the perforator artery in the operation can improve the survival rate of the flap. The design of the KISS flap is more flexible and reliable, which is worthy of promotion.
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Objective To investigate the clinical effect of the iliac periosteal flap with ascending branch of lateral femoral circumflex artery for the treatment of Legg-Calvé-Perthes disease.Methods Followed-up 18 patients with Legg-Calvé-Perthes disease who had undergone the treatment of iliac periosteal flap with ascending branch of lateral femoral circumflex artery from January,2008 to May,2012 in our hospital.Minimum follow-up time was from 24 to 60 months,and the average time was 38 months.The followed-up period ended in May,2014.Assessed the effect of surgery by X-ray,clinical examination and Harris scoring system.Results Sixteen patients had good healing with iliac periosteal flap according to X-ray show.Their epiphyseal height recovered and the femoral head rounded gradually.Two cases became flat and collapse.The result of excellent and good rate was 88.9％ by Mose method combined with the results of X-ray.The average Harris hip score improved from 72.3 ± 4.9 points preoperatively to 91.3 ± 2.4 points postoperatively.The difference of the result was statistically significant (P ＜ 0.05).Conclusion The transfer of iliac periosteal flap with ascending branch of lateral femoral circumflex artery is an effective treatment for Legg-Calvé-Perthes disease.
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Objective To summarize the clinical efficacy of free KISS lateral femoral circumflex artery perforator flap in repairing defects of limbs.Methods Twelve cases were suffered wound surface defects on hands and feet.And the defects were repaired by flap construction from October,2010 to May,2013,based on the characteristics of the defects combined with anatomical features of the free lateral femoral circumflex artery perforator flap.Length of flap was adopted as the width for direct suture in the flap donor.Results Postoperative flap and donor area preliminarily healed.There was no vascular crisis.Twelve cases received 6-18 months followed-up (averaged of 12 months).The skin flap was good in color and texture.The dorsal flap was a bit bloated.Linear scar was remained in distal flap donor area.The quadriceps muscle power level 5,knee flexion,extension 10°-180°.Quadriceps strength,knee flexion and stretch activities were all normal.The flaps recovered protective sense.Four cases had tendon adhesion after hand tendon transplantation.The finger function was well recovered after release.At the last followup,the functions of the upper limbs were evaluated according to the trial evaluation standard of the Hand Surgery Association of Chinese Medical Association:6 cases were excellent,1 case was good,and 1 case was qualified.Conclusion The design of the lobulated tissue flap of the lateral femoral circumflex artery descending branch is flexible.Large area of the surface defect can be repaired.The flap donor area is directly sutured.It is an ideal method to repair the wound tissue defect.
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Objective To compare open reduction and cannulated screws combined with ascending branch of lateral femoral circumflex artery iliac bone flap with closed reduction and cannulated screw fixation for the treatment of displaced femoral neck fracture in young adults.Methods From January 1992 to January 2007,totally 204 cases of displaced femoral neck fracture were treated.Group A:one hundred and three cases were treated with open reduction and 2 cannulated screw fixation,covered by the vascular pedicled iliac bone flap with ascending branch of lateral femoral circumflex artery.Garden classification:type Ⅲ.68 cases,type Ⅳ:35 cases.Group B:one hundred and one cases,treated with closed reduction and three cannulated screw fixation.Garden classification:type Ⅲ in 62 cases and type Ⅳ in 39 cases.Results Two groups were followed up for 5-15 years.The healing time of group A was (73 ±21.2) days,including 4 cases of nonunion fracture (3.9％) and 5 cases of femoral head avascular necrosis occurred (4.9％) ; The healing time of group B was (89 ± 12.5) days,including 12 cases of nonunion fracture (11.9％) and 18 cases of femoral head avascular necrosis occurred (17.8％).The healing time,the rate of nonunion of fracture and the rate of femoral head necrosis were significantly different of these 2 groups.Conclusion The treatment of open reduction and 2 cannulated screw fixation,covered by the vascular pedicled iliac bone flap with ascending branch in young adults can effectively prevent nonunion of fractures and osteonecrosis of the femoral head.
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Objective To evaluate the feasibility and clinical efficacy of lateral femoral circumflex artery perforator flaps and fit together in the treatment of limbs complex wound surface.Methods From January 2010 to March 2012,use the characteristics that the descending branch of lateral femoral circumflex artery extend its branches over the flap,fascia and skin,to form lenticulostriate arteries,which contain 2 to 3 different species tissues fits together,flaps cover the important tissues such as vessel,nerves and bones.Fascia covers the tendinous tissues etc.Muscle can not only cover the tissues,but also fill in the space,and followed by skin grafting.This research was to perform the treatment for 4 cases of lacking limbs ring tissue,three cases of multiple wound surface,six cases of hand avulsion injury of skin and 9 cases of Gustilo grade-Ⅲ C.Results As for the 22 cases in the research,nineteen cases of flaps survived,the other 3 cases were necrosis with length of 1cm to 2 cm at distal and self-healed later.During 6 months to 2 years followed-up of 18 cases,external flaps were satisfactory,skin grafting over the fascia layers develops very well,smooth with great elasticity,no recoil,and no color change.Conclusion Lateral femoral circumflex artery is one of effective restoration methods for limbs with complex wound surface.