Anatomical Basis Of The Chimeric Perforator Flap Of The Lateral Femoral Circumflex Artery

Objective: By means of microscopic dissect and blood latex-injected, we had major investigated the morphological features of the three major branches of the lateral femoral circumflex artery which including the ascending branch, the transverse branch and the descending branch, and a series of perforating branches. The main objectives we wanted to reached were:(1)To provide anatomical basis for the chimeric perforator flap of the lateral femoral circumflex artery and design applicable patterns in repair of the general multiple soft tissue defects.(2)To explore new flap operation for the development of microsurgery and traumatic orthopedics, which was beneficial to clinician.(3)To put forward innovation on the basis of previous studies in relevant areas.Methods: 28 embalmed lower limbs of adult cadavers were used for the anatomic study, they were all perfused with red latex. Followings were observed by microsurgical technique.(1)The origins, courses, distributions of ascending branch of lateral femoral circumflex artery;(2)the courses and distributions of transverse branch of lateral femoral circumflex artery;(3)the courses and distributions of descending branch of lateral femoral circumflex artery. Two sides of fresh specimen were used for designing and performing mimic operations.Results:(1)The ascending branch was derived from the lateral femoral circumflex artery which forward in the upper thigh, it was located(10.4±0.8)cm proximal to the anterior superior iliac spine and passed through(8.9±0.4) cm before penetrating the muscle. The length of the stem was(7.8±0.9) cm and the outer caliber was(2.5±0.4) mm. There were certain accompanying branches of the lateral femoral cutaneous nerve at the origin which used accompany with two vein vessels. The iliac crest branch gave off many minute branches emerged about 2cm at the anterior superior iliac spine and the occurrence rate was 46.63%. The transverse branch of femoral circumflex artery gave off two greater trochanter branches at the inferior greater trochanter, accounting for 85.71%, the other rate that it gave off only oneperforator was 14.29%, the outer caliber of the stem was(0.3±0.1)mm. As a constant branch, the outer diameter of the upper femoral periosteal branch was(0.4±0.2) mm.The outer caliber of the ascending and inferior branches of tensor fasciae latae branch were(1.2±0.8) mm and(1.0±0.6) mm respectively. The length of middle gluteal muscle branch was(4.0±1.3) cm and the outer diameter was(1.0±0.3) mm. The outer diameter of the high cutaneous artery before giving off some branches was(2.6±0.4)mm, and at which penetrated tensor fasciae latae was(0.80±0.04) mm.(2)The descending branch of lateral femoral circumflex artery which was located(27.8±3.5) cm proximal to the patella center gave off medial and lateral branches. The lateral branch gave some musculo-cutaneous arteries and septocutaneous perforating branches whose outside diameter were(0.7±0.2) mm. Among the arteries, the length of whose outer diameter over 0.5mm was(20.3±2.6) cm. The outer diameter of the medial branch was(2.1±0.6) mm. Among the branches supplying for vastus intermedius, the length of whose outer caliber over 0.5 mm was(15.9±3.6) cm. The rectus femoris branch located(31.0±3.1) cm above the patellar midpoint emerged from the stem. The outer diameter was(2.1±0.3) mm. Among the branches, the amount of the muscular branches were(3.1±1.1), of the cutaneous branches were(2.2±0.9). The length of the vastus intermedius branch was(5.1±1.7) cm. The length of it from the point entering muscle to patellar midpoint was(27.6±3.0) cm.The vastus lateralis muscle branch emerged from the transverse branch of femoral circumflex artery,which was located(34.4±1.2) cm above the patellar midpoint. The length and the outer diameter were(4.8±1.0) cm,(2.3±0.4) mm respectively, the length of the branch from muscle to patellar midpoint was(31.3±1.8) cm.Conclusion:(1)We had learned the morphological features and anatomical regular of the lateral femoral circumflex artery which including the three branches.We also had clear and definited that the anastomoses between these perforator arteries;(2)Based on these anatomical researches, we had designed chimeric perforating flaps pedicled with the ascending branch or the descending branch. All these flaps could be used to repair soft-tissue defects soft-tissue defects in extremities;(3)These flaps could be designed and operated easily and flexibly, which were supplements in repairing for soft-tissue defects in extremities.