A Microdissection Study And Clinical Application Of Perforator In The Medial And Posterior Thigh Region

Background The new development of perforating flap in area of microsurgery flap transplantation is accord with tissue transplanting principle:the recipient site is being repaired well, the donor site is being destoried little. The80percent clinical flap planting is to cover superfacial skin and soft tissue, only a little is to obdurate dead space or deep part defect. So the perforating flap which contains subcutaneous fat and skin is in accord with the principle "what short of what make up for". The anatomy study of perforator flap is often related2D level in our country. Yet realy3D study which can guide clinical operation is little to be reported. The reason is that deficienting of anatomy materials, without well operating skill, etc.Nevertheless the key to design perforating flap and anticipate effect Flap area is based on detailed anatomic form. Now the reason of few application of medial thigh region perforating flap is that much study of base of microanatomy not be certained. Such as the number and courser of perforating vascular;the group of vascular amstomotic; the company venous return;and the neuro-cutaneous distribution and domination. Yet this study need suitable microanatomy technique, micro-instrument and microscope. Therefor, it is important for us to know the microanatomy study of perforator in the medial and posterior thigh region. So we can do better to design and make operation.Objective:To investigate the anatomic features of perforating branch flap of the medial and posterior region, so as to provide a new perforator flap for repairing the soft tissue defect. Because the skin of anteromedial thigh region usually is thinner, pliable, hairless it can be prefered based on the requirements of the recipient site. In this way more information is necessary about the perforators of anteromedial thigh region. The aim of this cadaveric study was described to provide useful knowledge about localizations and number of anteromedial thigh perforators and the posterior thigh region. Methods:Study was carried out on10lower extremities of adult cadavers. The area in anteromedial and posterior region of the thigh were searched for perforators. The diameters of the dissected perforators were measured and the locations were documented. Ten fresh lower limb specimens underwent a intra arterial injection of a lead oxide and gelatin preparation. The integument of the thigh was dissected, and perforators in anteromedial and posterior region of the thigh were identified. Their type (septocutaneous versus musculocutaneous),course, size, and location were documented by angiography and photography. Posterolateral thigh perforator flap were used in6patients with the soft tissue defects, Anteromedial thigh perforator flap were used in5patients,free medial vastus muscle perforator flaps were used in6patients, perforator flap of superior medial genicular were used in8patients.Results:1the anatomy of the posterior thigh regionOrigin of all perforators was determined from deep femoral artery, proximal part of femoral artery and distal part of femoral artery and their branches, especially distal part of femoral artery and their branches. Perforators with the largest diameter were the ones arising. The artery of the medial vastus sent out from the femoral artery at the peak of femoral triangle, and then descended in the vastus muscle,and sent out4-7musculocutaneous perforating branches till lateral patella anastomosing with arterial circle around patella.2the anatomy of the anteromedial thigh regionIt is deficient of named axial arteryof the anteromedial thigh region. The arterial supply to the integument of the anteromedial thigh was divided into proximal, middle, and distal zones. There were (21±4.0) perforators with diameters of greater than or equal to0.5mm; the average external diameter was (0.8±0.1) mm. The length of perforator was (4.5±2.1) cm. Each perforator supplied an average area of (44±4.8)cm2. A number of perforators arised from the femoral artery, lateral circumflex femoral artery, and descending genicular artery in the middle zone of the anteromedial thigh.3clinical result All flaps survived after operation with the donor sites healed by first intention.After following up for6-12months, the appearance and function of the flaps were all satisfactory with excellent texture. No flap was completely lost. No complications developed at the donor or recipient sites.Conclusion:1Perforator flap is the improvement on the traditional Myocutaneous flap, which reduces the morbidity of the donor site with preservation of the nerves, muscles. The appears is not too bloated at the recipient site without muscles and fascias involved. Perforator flap is not only meeting the aesthetic requirements of the patients, but also complying with advantage for functional exercise. Perforator flap is a new technology for tissue defect repair and the newest trend of development in flap surgery.2Since the digitized image of perforator territory can accord with the morphology of anatomy,and can off vascular structure insights into cutaneous perforator anatomy,their3D visualizative models can be applied in pre-operative designing and virtual operation procedures, and can be helped for study of perforator flap.3The posterolateral thigh perforator flap、Anteromedial thigh perforator flap、free medial vastus muscle perforator flaps and perforator flap of superior medial genicular were used in patients with tissue defects. It can be good alternative to repair the soft tissue defect with excellent texture.