Compartment syndrome of the thigh is a rare condition, potentially resulting in devastating functional outcome. Increasing intracompartmental pressure which suppresses microcirculation and capillary perfusion may lead to cellular anoxia and muscle ischemia. The muscle compartments in the thigh have a more compliant fascia and blend anatomically into the open compartments of the pelvis, thus compensating higher volumes than the compartments in the lower leg. We present a previously unreported case in which the limb of a 36-year-old man was run over by a 25-ton truck. He presented with a sensomotor deficit in his left lower leg with full paralysis of the shank muscles and absence of all foot pulses. CT scan showed a huge haematoma in the thigh with active bleeding out of the popliteal artery into the haematoma which has already expanded into the muscle compartments of the lower leg. The limb had a disastrous compartment syndrome of the thigh and lower leg with disruption of the popliteal neurovascular bundle; however, no bones in the limb were fractured. A complete fasciotomy of all the lower limb muscle compartments was immediately performed. The artery was reconstructed with interposition of the smaller saphenous vein, which was already interrupted through the initial trauma.
Accidents, Traffic ; Adult ; Compartment Syndromes ; physiopathology ; Humans ; Leg ; blood supply ; innervation ; Male ; Thigh ; blood supply ; innervation

OBJECTIVETo study the anatomy of the anterolateral thigh perforators flap and explore its clinical application in the reconstruction of head and neck defects.

METHODSFive adult fresh cadavers were prepared, and morphosis and blood supply of anterolateral thigh flap perforators were examined by microsurgery anatomy. During dissections, the following parameters were recorded: number and type of perforators vessels, diameter of perforators, pedicle length, diameter of the original vessels, route (infra fascia and supra fascia); its position were located by anatomical landmark.

RESULTSThere were an average of (4.4 +/- 1.8) anterolateral thigh perforators flaps (ALTP flap) in each specimen with 68.2% musculocutaneous perforator and 31.8% septocutaneous perforator. The mean pedicle length of the largest perforator was (10.86 +/- 1.18) cm (8.29-14.44) cm, and its location was constantly concentrated in the superolateral region of the midpoint of the line linking the anterosuperior iliac spine and superolateral border of the patella. The distance between surface location of the largest perforator and the midpoint was (3.25 +/- 0.69) cm. Original vessel was mostly descend branch of lateral circumflex femoral artery/vein with average diameter of (3.16 +/- 0.59) / (3.08 +/- 0.02) mm.

CONCLUSIONALTP flap has constant position, large caliber, and long pedicle and therefore is useful for operation and option in reconstruction of head neck defects.

Aged ; Autopsy ; Head ; surgery ; Humans ; Middle Aged ; Neck ; surgery ; Reconstructive Surgical Procedures ; Surgical Flaps ; blood supply ; Thigh ; blood supply ; surgery

OBJECTIVETo investigate the blood vascular distribution of supra-genicular flap and to apply the retrograded supra-genicular flap for reconstructive surgery.

METHODSEight fresh adult cadavers with 16 lower extremities were used for the study, by means of injecting the media of red latex into the main artery of the limb. The skin vascular architecture on the lower two thirds of each thigh was observed to decide the blood supply of this region. Fifty-two patients were also used to treat the scarring contraction of the popiteal fossa with 56 of the retrograded supra-genicular flaps, and long-term follow-ups were carried out.

RESULTSFrom this study, it was found that there are rich blood vascular networks of the skin above the knee anteriorally, laterally and medially. The abundant vascular anastomoses were also found around the knee. The clinical application of the retrograded supra-genicular flap was successfully carried out for the treatment of the scarring contraction of the popiteal fossa. All of the flaps were survived well. Long-term results were satisfactory.

CONCLUSIONThe above mentioned flap is a safe and effective flap for repair the defect of the popiteal fossa.

Adolescent ; Adult ; Burns ; complications ; Cadaver ; Child ; Child, Preschool ; Cicatrix ; etiology ; surgery ; Humans ; Knee ; blood supply ; Male ; Surgery, Plastic ; methods ; Surgical Flaps ; blood supply ; Thigh ; blood supply ; Treatment Outcome

OBJECTIVETo investigate the blood supply patterns of the anteriorlateral thigh adipofascial flap for clinical applications.

METHODSTo investigate the blood supply patterns of the anteriorlateral thigh (ALT) adipofascial flap, 16 fresh cadavers were anatomically examined by intraarterial injection of colored latex. Three-dimensional analysis of the vasculature of the subcutaneous adipofascial tissue was performed. Sixteen patients underwent microsurgical correction with the ALT adipofascial flap. Among them, there were fifteen with hemifacial atrophy, one with micromastia.

RESULTSThe three-dimensional arterial structures of the ALT adipofascial flap were the same in all the cadaver specimens. Each layer of the adipofascial tissue was supplied by several blood vessels of the axial pattern, especially in the deep layer. Sixteen patients were successfully treated with this flap. The postoperative follow-up ranged from six months to eleven years. There was not postoperative flap necrosis or absorption of the fatty tissue. Stable restoration of the facial contour or the breast was achieved. The donor-site morbidity was minimal.

CONCLUSIONThe blood supply of the ALT adipofascial flap is reliable. A considerable amount of the fatty layer of the flap can be removed primarily. It is a preferable procedure for reconstructing soft tissue defects.

Adipose Tissue ; Adolescent ; Adult ; Breast ; surgery ; Female ; Humans ; Male ; Mammaplasty ; methods ; Surgical Flaps ; blood supply ; Thigh

OBJECTIVETo provide algorithmic morphological data that enables safe elevation of the flow-through perforator flap, chimeric perforator flap in the thigh.

METHODS15 fresh cadavers were injected with a modified lead oxide-gelatin mixture for three-dimensional reconstruction using a spiral computed tomography scanner and specialized volume-rendering software (MIMICS). All of specimens were then dissected by layers. Angiography and photography were used to document the precise course, size, location, and type of individual perforators in the thigh region. The surface areas of cutaneous territories and perforator zones were measured and calculate with Photoshop and Scion Image.

RESULTSThe main artery supplying the thigh is femoral artery. There are (41 +/- 4.0) perforators whose outer diameters > or = 0.5 mm. These perforators have a superficial pedicle length of (4.2 +/- 1.7) cm. The average outer diameter is (0.8 +/- 0.1) mm. Each perforator supplies an average area of (44 +/- 6.4) cm2. There are lots of truly anastomoses among perforaors to form a subcutaneous network in the thigh.

CONCLUSIONSThe volume rendering technique is very useful for showing the subcutaneous network and preoperative flap design. The thigh appears to have the greatest potential for harvesting new or modified perforator flaps, especially, flow-through perforator flap or chimeric perforator flap.

Cadaver ; Femoral Artery ; physiology ; Humans ; Perforator Flap ; blood supply ; Regional Blood Flow ; physiology ; Thigh ; blood supply ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

This study was done to identify the normal and variants of saphenous tributaries in Korean adults. The pattern of confluence of saphenous tributaries, medial accessory saphenous, lateral accessory saphenous, superficial epigastric, superficial circumflex iliac and superficial external pudendal veins, was carefully examined in 249 lower limbs (right, 129; left, 120) of embalmed Korean cadavers (73 males and 56 females). The medial accessory saphenous vein drained into the great saphenous vein directly (in 82.3%) or by a common trunk (in 17.7%) with the superficial epigastric or superficial external pudendal vein. The lateral accessory saphenous vein entered the great saphenous (in 67.1%) or the femoral vein (in 32.9%) directly or, forming a common trunk with other saphenous tributaries. The superficial epigastric vein joined the great saphenous (in 77.1%) or the femoral vein (in 22.9%) directly or, by a common trunk with other saphenous tributaries. The superficial circumflex iliac vein reached the great saphenous (in 83.1%) or the femoral vein (in 16.9%) directly or, by a common trunk with other saphenous tributaries. The superficial external pudendal vein opened into the great saphenous (in 95.2%) or the femoral vein (in 4.8%) directly or by a common trunk with other saphenous tributaries. In Koreans, the incidence of the normal pattern of saphenous tributaries was 23.7% and in 76.3% any one of variant saphenous tributaries entered the femoral or the great saphenous vein by a common trunk with other saphenous tributaries.
Adult ; Cadaver ; Femoral Vein/*anatomy & histology ; Humans ; Iliac Vein/*anatomy & histology ; Korea ; Saphenous Vein/*anatomy & histology ; Thigh/*blood supply

OBJECTIVETo analyze the feasibility and reliability of free anterolateral thigh flap transfers in head and neck reconstruction.

METHODSTwenty-two consecutive free anterolateral thigh flap transfers from January 2002 to January 2006 were reviewed. Data concerning the operation included date of surgery, defect description and site, stage and histology of tumor, design of anterolateral free flap, type of perforators, recipient vessel and type of anastomosis used and complications.

RESULTSThere were 13 males and 9 females in this group, with age range of 35 to 70. Among 26 perforators, there were 6 septocutaneous perforators and 20 musculocutaneous perforators. One flap developed venous thrombosis 48 hours after operation, and the flap was removed after failed salvage. No vessel thrombosis occurred during and after operation with other flaps, which survived completely. All the donor sites were closed directly without skin graft. Apart from one case, all the donor sites healed uneventfully.

CONCLUSIONSFree anterolateral thigh flap is a safe and reliable donor site in the reconstruction of head and neck defects. It overcomes the shortcomings of traditional free radial forearm flap and free rectus abdominis myocutaneous flap.

Adult ; Aged ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Surgical Flaps ; blood supply ; Thigh ; surgery ; Treatment Outcome

OBJECTIVETo investigate the application of the island flap based on the postfemur neurocutaneous nutrient vessel.

METHODSThe flap was designed and applied to repair the defects in the gluteal, popliteal fossa or the bilateral postfemur areas. A total of 11 cases (12 defects) were treated with this method. The size of the defects ranged from 4.0 cm x 7.8 cm to 8.3 cm x 16.6 cm.

RESULTSOf the 12 defects, 9 achieved complete success. Epidermal necrosis occurred in the distal part of the flap in 3 defects owing to venous stasis, which were cured with skin grafting. Postoperative follow-up for 8-19 months showed that the appearance, texture, and function of the flap were satisfactory.

CONCLUSIONSThe advantages of the flap lie in the reliable blood supply, constant anatomy, and without sacrificing a major artery. The key points for the flap survival are utilizing the "Superficial vein-nutrient vessel of the cutaneous nerve system" and retaining a comet tail-shaped soft-tissue pedicle in the flap creation.

Arteries ; Follow-Up Studies ; Humans ; Necrosis ; etiology ; surgery ; Skin ; injuries ; pathology ; Skin Transplantation ; Surgical Flaps ; blood supply ; pathology ; transplantation ; Thigh ; Wound Healing

OBJECTIVETo investigate the feasibility of free descending genicular artery perforator flaps in the soft tissue defects at extremities.

METHODSTen fresh cadavers were injected with lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized volume-rendering software ( Materiaise's interactive medical image control system, MIMICS). The origin, course and distribution of the perforators in the thigh and leg region were observed. 11 patients with skin defects at the distal part of extremities were treated. The flap size ranged from 5 cm x 8 cm to 6 cm x 15 cm. Six flaps were pedicled with the descending genicular artery and the others were pedicled with the perforator of the descending genicular artery. All flaps were transferred by end to end anastomosis. RESULTS The follow-up period ranged from 6 to 18 months. All the flaps survived. The appearance and texture of the flaps were good with sensory recovery of S3.

CONCLUSIONSFree descending genicular artery perforator flap has a reliable blood supply and suitable thickness for the treatment of soft tissue defects at extremities. The technique is easily performed with reliable results.

Arteries ; Cadaver ; Extremities ; injuries ; Feasibility Studies ; Follow-Up Studies ; Humans ; Leg ; Perforator Flap ; blood supply ; transplantation ; Soft Tissue Injuries ; surgery ; Thigh ; Upper Extremity

OBJECTIVETo investigate the clinical application of pedicled superficial circumflex iliac artery (SCIA) flaps in Burns and Plastic Surgery.

METHODS19 cases with skin and soft tissue defects were repaired with the Superficial circumflex iliac artery flaps. The defects located in the hand and forearm, the lower abdomen and perineal area, the radicle area of thigh, etc. Before the SCIA flaps were transfered to the recipient areas, 15 cases with different kinds of wounds were debrided thoroughly, 3 cases with scar were removed directly. The size of the flaps ranged from 3.0 cm x 4.5 cm to 26.0 cm x 22.0 cm, and the pedical was 5 cm to 7 cm in length.

RESULTSThe flaps in the 18 cases survived completely. Skin necrosis in the distal end of the flap appeared in 1 case, and the wound healed after the second repair. The follow-up period rang from 3 to 18 months. The apperance and function of the hand or foot was satisfactory.

CONCLUSIONSBecause the pedicled SCIA flaps can be obtain conveniently and contain sufficient blood-supply, so the flap is easy to survive and the flap can be designed in a large size. We believe it is an ideal method to use this flap to repair skin and soft tissue defects located in hands, forearms, the lower abdomen and perineal areas, the radicle area of thigh and so on.

Burns ; surgery ; Forearm ; Graft Survival ; Hand ; Humans ; Iliac Artery ; Necrosis ; Reconstructive Surgical Procedures ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; pathology ; transplantation ; Thigh ; Wound Healing