Distribution characteristics and clinical application of perforators of anterolateral thigh flap pedicled with oblique branch of lateral circumflex femoral artery
10.3760/cma.j.cn114453-20230213-00031
- VernacularTitle:以旋股外侧动脉斜支为蒂股前外侧皮瓣的穿支分布特点与临床应用
- Author:
Lin YANG
1
;
Yang CAO
;
Junnan CHENG
;
Yongtao HUANG
;
Zhijin LIU
;
Qinfeng GAO
;
Chengpeng YANG
;
Fengwen SUN
;
Yucheng LIU
;
Jihui JU
Author Information
1. 苏州瑞华骨科医院手外科，苏州 215104
- Keywords:
Surgical flaps;
Perforator flap;
Anterolateral thigh flap;
Oblique branch of the lateral circumflex femoral artery;
Distribution characteristics of perfor
- From:
Chinese Journal of Plastic Surgery
2023;39(5):463-471
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the distribution characteristics of the perforators of the oblique branch of the lateral circumflex femoral artery, and to report the clinical effect of the anterolateral thigh flap pedicled with the oblique branch in repairing the wounds of the extremities.Methods:The clinical data of the patients with anterolateral thigh flap pedicled with oblique branch of lateral circumflex femoral artery in Suzhou Ruihua Orthopaedic Hospital from December 2020 to April 2021 were analyzed retrospectively. High frequency color Doppler ultrasound was used to detect the large perforators of the oblique branch of the lateral circumflex femoral artery near the midpoint of the line between the anterior superior iliac spine and the lateral margin of the patella. With reference to the location of the perforators, according to the size and shape of the defect in the recipient area, the anterolateral thigh flap pedicled with oblique branch was designed and dissected to repair the wound. During the operation, the distance between the emitting point of the main oblique branch, the skin entry point of the perforators and the anterior superior iliac spine was measured with a steel ruler, the diameter of the perforators was measured with a microscale, and the number of perforators was counted. The survival and complications of the flap were observed and followed up after operation. In the last follow-up, the comprehensive evaluation scale was used to evaluate the repair effect: 90 to 100 points is excellent, 75 to 89 points is good, 60 to 74 points is average, and less than 60 points is poor.Results:A total of 84 patients were included, including 62 males and 22 females, aged from 14 to 82 years (mean 46.9 years), including 32 cases of hand wounds, 6 cases of forearm wounds, 3 cases of upper arm wounds, 10 cases of calves and 33 cases of foot and ankle wounds. The wound area was 6 cm × 4 cm-20 cm × 45 cm. A total of 88 flaps were removed in 84 patients (skin flaps on both thighs were removed in 4 patients). The size of the skin flap of 88 thighs was 7 cm × 5 cm-37 cm × 11 cm, of which 85 sides of 82 cases survived completely. One case of diabetes had complete necrosis 1 month after operation, and 1 case of 34 cm had necrosis of the distal end of 3 cm × 3 cm skin flap. Necrotic skin flaps were repaired with skin grafting. Four patients developed arterial crisis within 24 hours after operation, and those flaps survived after surgical exploration. All donor areas healed. During the follow-up of 6 to 9 months, the shape of the recipient area was normal in all patients, and there was no deep tissue infection such as osteomyelitis. The color and texture of all flaps were good. The sensation returned to S1-S2 after operation. The skin flap comprehensive evaluation scale was used to evaluate the repair effect. The patients’ score ranged from 73 to 94 points, with an average of 88.1 points. Including 33 excellent cases, 46 good cases and 5 average cases, the excellent and good rate was 94.0%(79/84). A total of 215 perforators were marked with 88 flaps before operation, and 208 perforators were found during the operation(the diameter of the perforators was 0.4-1.5 mm), of which 130 were sent out by oblique branches. There were perforators of the oblique branch in all flaps, with an average of 1.5 on each side, including 84(64.6%) septocutaneous perforators and 46(35.4%) musculocutaneous perforators. Most of the oblique branches originate from the lateral circumflex femoral artery, which runs in the intermuscular septum between the rectus femoris and the intermediate femoris muscle. It is divided into deep branches and superficial branches at the middle and upper 1/3 junction of the line between the anterior superior iliac spine and the lateral margin of the patella. The skin perforators of the oblique branch of the lateral circumflex femoral artery is mostly sent out from the superficial branch, and there are 118 perforators located at the midpoint and proximal end of the line between the anterior superior iliac spine and the lateral margin of the patella, accounting for 90.8% (118/130), reaching a peak at 0.4 (there are 37 perforators).Conclusion:The oblique branch of the lateral circumflex femoral artery is relatively constant, and most of the perforators are located near the midpoint of the line between the anterior superior iliac spine and the lateral margin of the patella, and the proportion of septocutaneous perforator is high. The distribution of perforator is regular, the blood supply is reliable, the application mode is flexible, and the donor site position is more concealed while the blood supply of the flap is secured.
