Applied Anatomical Study On The Lateral Crural Flap With The Cutaneous Branch

Objective We investigate the applied anatomy which is related to transplantation of the lateral crural flap with the cutaneous branch, to provide anatomical basis for design and practice of the operation.Material and Methods 1.40 lower limbs of 20 adult cadavers fixed by formaline were used to observe the blood vessels. 2. The arteries of a lower limb of the fresh cadaver were injected with latex solution and the ones of another lower limb with ink to observe location of origin, external diameter, course, neighboring structure, emerging point and branches in deep fascia layer of the cutaneous branches which supply the lateral crural flap. 3. In 30 legs of 15 adult volunteers, the emerging points of cutaneous branches of the artery were detected by Ultrasonic Doppler Flowmeter. 4. In 12 clinical cases, transplantation of the lateral crural flap with the cutaneous branch was performed to observe the effect of the operation.Results 1. In 40 cadaver legs, 140 cutaneous branches were observed and average of each leg was 3.5 branches. 2. Most cutaneous branches from fibulax artery (76.43%) were located hi the region which was 7~21 cm below the topmost point of the fibular head. External diameter of the thickest cutaneous branch in each leg was 1.8 ± 0.4mm (1.4~2.9mm) . External diameters of the two accompanying veins were 2.9±0.5mm (1.8-4.8mm) and 2.4±0.4mm(1.4-3.6mm), respectively. 4. The cutaneous branches of the artery can be divided into 7 types: (1) cutaneous branch of high location; (2) direct cutaneous branch; (3) periosteal cutaneous branch; (4) intermuscular septal branch; (5) myocutaneous branch of soleus; (6) myocutaneous branch of flexor hallucis longus; (7) myocutaneous branch of peroneus longus and brevis. 5. Clinical application has been performed in 12 cases. The flap size was 15~28 X 6~11cm and all of the 12 flapssurvived.Conclusion 1. The cutaneous branch and the flap nourished by it can be treated as a flapunit. 2. The lateral cutaneous branch flap transferred with cutaneous branch of the arteryas pedicle can bring minimal operative trauma and simplifies the operative procedure. 3.The criteria for selection of vascular pedicle are: the main branch of the artery; thethickest branch; the branch located in middle segment of the flap; direct cutaneousbranch.