Design and clinical applications of the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery / 中华整形外科杂志

ABSTRACT

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.