Clinical Type And Application Of Oblique Branch Of Lateral Circumflex Femoral Artery Perforator

Background and Objective: The lateral circumflex femoral artery perforator flap is known for variations of its vascular pedicle. This is a prospective intraoperative analysis of the vascular anatomy of the lateral thigh that focuses on clinically important type that impact flap harvest.And to explore effect of the oblique branches perforator type of lateral circumflex femoral artery and the application of the perforater flap. Methods: From January 2014 to January 2016,a prospective intraoperative observational study was performed in 58 consecutive anterolateral thigh flaps. We found 21 patients with the oblique branches and noting the dimensions and locations of the oblique and descending branches and the number and size of the muscle branches supplying the rectus femoris and performed the free flap pedicled with collateral branch of oblique rarus of lateral circumflex femoral artery to fix the hand,foot and ankle in 12 cases. There were 8 males and 4 female with an age range from 11 to 54 years(mean, 32 years). T hey were injured by traffic accident(6 cases), object hit from height(2 cases), injured by machines(1 case),falling(2 cases) or hurted by electric burns(1 case). Soft tissue defect loca ted at the dorsum of foot in 5 cases, at the ankle in 2 cases and the distal shank in 2 cases, 2cases at the hand and 1 case at the wrist.The disease duration was 4 hours to 36 hours(mean, 16 hours). 6 skin flaps,4 fascia flap plus skin flap,2 ramified flaps harvest were then completed as planned. The area of Soft tissue defect after debridement: 6 cm × 4 cm ~ 30 cm× 18 cm. The size of flaps ranged from 8 cm × 6 cm to 31 cm × 12 cm, and the donor sites were closed directly in all cases. Results: On the basis of the dimensions and locations of the oblique and descending branches supplying the rectus femoris, all cases are devided into type I(descending branch,16 cases,76%),type II(the oblique and descending branche,2 cases,9%),type III(oblique branch,3 cases,14%). After operation, all the flaps survived, the donor site primary healing in 11 cases, while wound dehiscence occured in 1 case and healed after dressing change and left a slash residual scar without pulling discomfort. The donor site was accompanied by a decrease in the range of peripheral sensory numbness. Early muscle strength of hip and knee arised in 3 cases, got better in 3 months and disappeared in 6 months.12 patients were followed up 3-24 months(mean, 13 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking.Conclusion:(1)Blood vessels should be carefully identified, while flaps were harvested with diversity of blood supply.(2)As it is improved that the oblique branch of lateral circumflex femoral artery perforator flap is simple and reliable, also can perform various forms of perforator flaps.