Nomenclature,Application And Potential Significance Of The Oblique Branch Of The Lateral Circumflex Femoral Artery

Objective:This article used the reverse-flow thigh flaps based on perforating vessels from different branches of the lateral circumflex femoral artery(LCFA)to repair soft-tissue defects of the lower extremity.We focused on investigating the characteristics of LCFA oblique branch and exploring the versatility and technical tips of soft-tissue defect reconstruction of the lower extremity using the reverse-flow thigh flaps based on perforating vessels from LCFAoblique branch.Methods:From November 2010 to December 2016,23 patients underwent defect reconstruction using the reverse-flow thigh flaps.There are 15 males and 8 females with an average age of 30.6 years(range,3～73 years).The LCFA oblique branches were found in 14 patients(accounting for 60.8%).Oblique branches derived from the descending branches in 10 cases(accounting for 43.4%),and transverse branches in 4 cases(accounting for 17.3%).The flaps were classified into four different types according to the origin of the perforating vessels on which the flap was based,including the descending(type Ⅰ),oblique(type Ⅱ),rectus femoris(type Ⅲ),and transverse branches(type IV).In our series of patients,there were 7 type Ⅰ flaps,10 type Ⅱ,5 typeⅢ,and 1 type IV.The reverse flow from the rectus femoris branch was combined wih that from the descending branch and a dual pedicle was formed in 5 patients.For flaps which was based on the oblique branch,there were 2 type Ⅰ flaps,10 type Ⅱ,1 type Ⅲ,1 type IV.The flap size ranged from 8cm×7cm to 22cm×13cm.The perforating vessels included septocutaneous in 7 cases and musculocutaneous in the remaining 16.The pedicle length and distance from the pivot point to the superolateral border of the patella were 8.5cm to 25cm(mean,17cm)and 5cm to 16cm(mean,11.48cm)respectively.Pre-transfer donor site expansion was conducted in 5 patients.The donor sites were closed primarily in 18 cases,aided by free skin grafting in 4,and transferring a pedicled deep inferior epigastric artery perforator flap in the remaining 1.Results:All flaps survived after the surgery except one in which the venous congestion of the flap occurred postoperatively and resolved after using conservative treatment.The patients were followed for 1 to 48 months,tumor recurrence were not noticed and all patients were happy with the reconstructive outcomes.Conclusion:In case the oblique branch presents,originates from the LCFA descending branch,and gives rise to perforating vessels nurishing the skin of the anterolateral thigh region,a reverse-flow thigh flap could be raised and used to reconstruct soft-tissue defects of the lower extremities.