Flow-through anterolateral thigh flap for simultaneous soft tissue and long vascular gap reconstruction in extremity injuries: anatomical study and case report.

SUMMARY: 47 dissections of cadaver thigh were studied to investigate pedicle configurations in the lateral descending branch of the lateral circumflex femoral arterial system, which can be used in harvesting a flow-through anterolateral thigh flap. The descending branch arose from the lateral circumflex femoral artery in 38 of the dissections, and the mean diameter at its origin was 3.0mm (range, 2.2-4.0mm). Skin peforators were of the solely musculocutaneous type in 37 dissections and were a combined septo-musculocutaneous type in 10 dissections. Pure septocutaneous perforator was not found in this study. During the descending branch's journey to the distal part of the thigh, several branches went into the vastus lateralis and vastus intermedius muscles. The diameters were tapering and the mean terminal diameter was 1.3mm (range 0.9-1.8mm), which required intraoperative judgment for proper matching of diameter of the flow-through pedicle and the recipient artery. The mean total length of the descending branch from its origin to terminus was 30.3 cm (range 22.5-37.1cm). In four dissections, the descending branch could not be used as a flow-through anterolateral thigh flap because the origin of the perforator arose from the transverse branch. A flow-through anterolateral thigh flap has several advantages, including a large cutaneous area, acceptable donor-site morbidity, adjustable thickness, the ability to combine adjacent muscle or fascia lata and the possibility of simultaneous reconstruction of long arterial gap and soft-tissue defects. Four patients with severe injury and a vascular gap of longer than 10 cm in the extremities were used to confirm the usefulness of this application.

Reconstruction of limb soft-tissue defects: using pedicle perforator flaps with preservation of major vessels, a report of 45 cases.

SUMMARY: We report on 45 pedicle perforator flaps without harvesting major vessels in limb reconstruction. Of our patients, 25 had major vessel injury resulting from their initial injury. In the upper extremities, there were 13 posterior interosseous artery perforator flaps, four ulnar artery perforator flaps and three radial artery perforator flaps. In the lower extremities, there were 16 peroneal artery perforator flaps with an axis on the sural nerve, five peroneal artery perforator flaps with an axis on the superficial peroneal nerve and four posterior tibial artery perforator flaps with an axis on the saphenous nerve. There were 42 successes, one total flap loss, one epidermal necrolysis and one distal tip necrosis. Greater utilisation of pedicle perforator flaps probably will occur because they are technically simple to execute, violate only the involved extremity, do not sacrifice a major source vessel, bring similar local tissues into a defect, avoid prolonged immobilisation and do not require microsurgical expertise. The concept of the pedicle perforator flap can be applied to the same axis of a neurocutaneous flap, even in cases with injured cutaneous nerves.

Anatomic variance in common vascular pedicle of the gracilis and adductor longus muscles: feasibility of double functioning free muscle transplantation with single pedicle anastomosis.

Fifty thighs from fresh human cadavers were studied to evaluate the feasibility of a double functioning free muscle transfer of the gracilis and adductor longus with single common vascular pedicle anastomosis. Methylene blue intra-arterial injection and loupe-magnified dissection were used to demonstrate three groups of vascular patterns in these two muscles. The common vascular pedicles of 88% of our specimen muscles were long enough for possible anastomosis. Ten percent (type B2) were quite short, making microsurgical procedure difficult. Two percent (type A3) of our specimens were not suitable for single anastomosis. Four percent of our gracilis muscles had two major arterial pedicles that branched from the common pedicle in a Y-shaped configuration. If only one pedicle of this type is harvested during a free gracilis muscle transfer, it may cause inadequate flap perfusion. Four specimens were studied using contrast media angiography to confirm both are Mathes and Nahai type II muscle flaps. In summary, this study typed the common vascular pedicle of our sample of gracilis and adductor longus muscles and confirmed the feasibility of double functioning free muscle transfer of the gracilis and adductor longus with single vascular anastomosis.