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.

Objective:To observe the path and anatomic distribution of cutaneous branch of second dorsal metacarpal artery(SDMA) from the back of hand to the web of the fingers, and to explore the feasibility and clinical effect on the transfer of free flap of SDMA.Methods:Between June 2018 and September 2018, with perfusion of red latex, 22 hand specimens were dissected to explore the course, vessel calibre and distribution of cutaneous branches of SDMA, and to discover the existence of an innervation of cutaneous nerve in Department of Hand Surgery of Tangshan Second Hospital. Later on, from February 2019 to July 2020, 2 thumb pulp defects of 2 patients were reconstructed with the free flaps of SDMA. One defect was in the left thumb and the other in the right, both were male and compression injuries. Size of thumb pulp and a skin defect was at 3.5 cm×2.0 cm in 1 patient, and 2.0 cm×2.5 cm in the other. There was no neurovascular injury, but 1 patient had a distal phalangeal fracture and a nail bed laceration. The sizes of the flaps were 3.8 cm×2.3 cm and 2.8 cm×2.5 cm. Functional exercises started from 3 weeks after surgery. Patients attended postoperation follow up regularly by outpatient visit, telephone or internet interviews. Follow-up observations included the appearance, texture, sensory recovery of the flaps and thumb functions.Results:Multiple perforating branches (4-9 branches) were found from SDMA, which distributed in the distal 1/3 of SDMA in the anatomic study. It was found that the outer diameter of SDMA was 0.76 mm±0.25 mm at the intersection of extensor tendon of index finger and that of the digital web artery was 0.71 mm±0.12 mm. The length of digital web artery was 11.00 mm±1.27 mm. The 2 surgically transferred flaps were all survived. One patient showed the function of thumb in excellent with two-point discrimination (TPD) at 7.0 mm, at 18 months of follow-up. The other patient showed good thumb movement, soft and elastic skin of the flap and with a 7.5 mm in TPD, at 15 months of follow-up. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the results of the 2 flaps were all excellent.Conclusion:The flap of SDMA has a constant cutaneous nerve and a long vascular pedicle with an ideal vessel size. It is suitable for free transfer and can be used to reconstruct soft tissue defects of thumb.