Anatomical classification of femoral artery perforator flap and its application in oral tumor reconstruction
10.3760/cma.j.cn114453-20220426-00131
- VernacularTitle:股动脉穿支皮瓣解剖分类及其在口腔肿瘤术后缺损修复重建中的应用
- Author:
Dajiang SONG
1
;
Zan LI
;
Yixin ZHANG
Author Information
1. 湖南省肿瘤医院肿瘤整形外科，长沙 410008
- Keywords:
Surgical flaps;
Perforator flap;
Femoral artery;
Muscle flap;
Free skin flap;
Oral tumor
- From:
Chinese Journal of Plastic Surgery
2022;38(10):1085-1093
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the anatomical classification of the femoral artery perforator flap and its application in the reconstruction of oral tumors.Methods:Retrospective analysis was made on the clinical data of oral cancer patients who were admitted to Hunan Cancer Hospital from December 2016 to December 2020. After radical resection surgery, free femoral artery perforator flap was used to repair soft tissue defects. According to the location of the perforator vessel pedicle, the flaps were divided into three categories. (1) Anteromedial proximal thigh perforator flap, the perforator vessels originate from the rectus femoris, medial femoris and sartorius muscles. (2) Medial thigh perforator flap, the perforator vessels from the anterior edge of the adductor longus. (3) The anteromedial distal thigh perforator flap, the perforator vessels from the medial femoral muscle. The specific harvesting methods include: (1) simple femoral artery perforator flap; (2) medial thigh myocutaneous flap combined with femoral artery perforator flap; (3) chimeric femoral artery perforator adductor longus myocutaneous flap. The donor site was closed after delamination and tension reduction. The survival and appearance of the flap, the swallowing and oral function of the patient, and the appearance and function of the donor site were followed up after the operation.Results:A total of 32 cases of the patients with oral tumors were included, consisting of 28 males and 4 females, aged from 37 to 54 years; 17 cases of tongue cancer, 10 cases of gingival cancer, 5 cases of buccal cancer; and the duration of disease was 2-13 months. After radical tumor resection, 5.5 cm× 3.5 cm-12.0 cm × 7.0 cm soft tissue defects were left. The perforator of femoral artery was found in all 32 cases during operation. Among them, the proximal perforator of anteromedial femoral artery was used in 12 cases. The flap was (11.3 ± 0.5) cm long, (5.1 ± 0.6) cm wide and (3.4 ± 0.3) cm thick. The medial femoral perforator was used in 6 cases. The flap was (10.8 ± 0.4) cm long, (5.0 ± 0.5) cm wide and (3.6 ± 0.4) cm thick. The anteromedial distal perforator was used in 14 cases. The flap was (11.5 ± 0.3) cm long, (4.6 ± 0.4) cm wide and (3.1 ± 0.2) cm thick. The form of flap: sixteen cases were simple femoral artery perforator flap, fourteen cases were femoral artery perforator flap with medial thigh muscle flap, and two cases were femoral artery perforator flap with adductor longus muscle flap. All 32 flaps survived after operation. The appearance and texture of the flap were good, without obviously bulky tissue, and the swallowing and speech functions recovered well. Only linear scars were left in the thigh donor area, and the thigh function was not significantly affected. There were 4 cases with local recurrence of tumor, and the tumor was repaired with pedicled pectoralis major myocutaneous flap after radical resection. One case recovered well, and 3 cases died of tumor metastasis. Three patients had cervical lymph node metastasis and recovered well after cervical lymph node dissection.Conclusions:The vascular anatomy of the femoral artery perforator vessel is constant. According to its location, different types of perforator flaps can be harvested from the proximal, distal or medial femoral anteromedial area. The femoral artery perforator flap is soft, and the anatomy of the perforator vessel is constant. The specific location and harvesting form of the donor site are flexible, and the donor site is less damaged. It is a good method for the repair and reconstruction of soft tissue defects after the removal of oral tumors.
