DESIGN AND CLINICAL APPLICATIONS OF DISTALLY BASED ANTEROMEDIAL THIGH FLAPS PEDICLED WITH PERFORATING VESSELS FROM RECTUS FEMORIS BRANCH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIULongcan ,  LIUYuanbo , ZANGMengqing , ZHUShan , CHENBo , LIShanshan

No. 11 Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical School, Beijing, 100144, P. R. China;

Corresponding author：

LIUYuanbo, Email: ybpumc@sina.com

Keywords：

Distally based anteromedial thigh flap; Rectus femoris branch; Descending branch; Lower extremity; Soft tissue defect; Wound repair

DOI：

10.7507/1002-1892.20160311

Video：

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Objective To explore the feasibility and technical essentials of soft tissue defect reconstruction of the lower extremity using the distally based anteromedial thigh flap (dAMT) pedicled with perforating vessels from rectus femoris branch. Methods Between July 2008 and December 2015, 6 patients underwent defect reconstruction of the lower extremity using the dAMT flap pedicled with perforating vessels from rectus femoris branch. There were 4 males and 2 females with an average age of 34 years (range, 4-55 years). The etiologies included liposarcoma in 1 case, malignant fibrous histocytoma in 1 case, post-burn scar contracture around the ankle in 1 case, and post-burn scar contracture around the knee in 3 cases. The disease duration ranged from 3 to 28 months (mean, 13 months). After resection of lesion tissues, the defect size ranged from 13 cm×7 cm to 24 cm×12 cm. The flap size ranged from 15 cm×8 cm to 24 cm×12 cm. The length of the pedicle ranged from 10 to 25 cm (mean, 19.8 cm). The distance from the flap pivot point to the superolateral border of the patella ranged from 8 to 13 cm (mean, 11.3 cm). The donor sites were directly sutured. Results All flaps survived postoperatively without any complications. All wounds at the donor and the recipient sites healed primarily. The patients were followed up from 5 to 36 months (mean, 17.8 months). The color, texture, and thickness of the flaps were similar to those of the surrounding skin. No tumor recurrence was observed. The range of motion of flexion and extension of the joint were greatly improved in the patients with scar contracture. Conclusion If the rectus femoris branch gives off cutaneous branch to the anteromedial thigh region and arises from the descending branch of the lateral circumflex femoral artery, a dAMT flap could be raised to reconstruct soft tissue defects of the lower extremity.

Citation： LIULongcan, LIUYuanbo, ZANGMengqing, ZHUShan, CHENBo, LIShanshan. DESIGN AND CLINICAL APPLICATIONS OF DISTALLY BASED ANTEROMEDIAL THIGH FLAPS PEDICLED WITH PERFORATING VESSELS FROM RECTUS FEMORIS BRANCH. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(12): 1502-1506. doi: 10.7507/1002-1892.20160311 Copy

1.	Song YG, Chen GZ, Song YL. The flap thigh flap:a new free flap concept based on the septocutaneous artery. Br J Plast Surg, 1984, 37(2):149-159.
2.	Koshima I, Hosoda M, Inagawa K, et al. Free medial thigh perforator-based flaps:new definition of the pedicle vessels and versatile application. Ann Plast Surg, 1996, 37(5):507-515.
3.	Cömert A, Altun S, Unlü RE, et al. Perforating arteries of the anteromedial aspect of the thigh:an anatomical study regarding anteromedial thigh flap. Surg Radiol Anat, 2011, 33(3):241-247.
4.	Baek SM. Two new cutaneous free flaps:the medial and lateral thigh flaps. Plast Reconstr Surg, 1983, 71(3):354-365.
5.	Yu P. Inverse relationship of the anterolateral and anteromedial thigh flap perforator anatomy. J Reconstr Microsurg, 2014, 30(7):463-468.
6.	Xu DC, Zhong SZ, Kong JM, et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg, 1988, 82(2):305-310.
7.	Wong CH, Wei FC. Anterolateral thigh flap. Head Neck, 2010, 32(4):529-540.
8.	张功林, 葛宝丰, 姜世平, 等.逆行股前外侧岛状皮瓣和肌皮瓣移植术.中华医学杂志, 1990, 70(12):676-678.
9.	Visconti G, Salgarello M, Visconti E, et al. Anatomy of anteromedial thigh perforators:CT-angiography study. Microsurgery, 2015, 35(3):196-203.
10.	Koshima I, Soeda S, Yamasaki M, et al. The free or pedicled anteromedial thigh flap. Ann Plast Surg, 1988, 21(5):489-485.
11.	Ao M, Uno K, Maeta M, et al. De-epithelialised anterior (anterolateral and anteromedial) thigh flaps for dead space filling and contour correction in head and neck reconstruction. Br J Plast Surg, 1999, 52(4):261-267.
12.	Jia YC, Chen HH, Kang QL, et al. Combined anterolateral thigh and anteromedial thigh flap for extensive extremity reconstruction:vascular anatomy and clinical application. J Reconstr Microsurg, 2015, 31(9):674-680.
13.	Yu P, Selber J, Liu J. Reciprocal dominance of the anterolateral and anteromedial thigh flap perforator anatomy. Ann Plast Surg, 2013, 70(6):714-716.
14.	Xu ZF, Sun CF, Duan WY, et al. Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck. Br J Oral Maxillofac Surg, 2013, 51(8):725-730.
15.	Koshima I, Hosoda M, Moriguchi T, et al. A combined anterolateral thigh flap, anteromedial thigh flap, and vascularized iliac bone graft for a full-thickness defect of the mental region. Ann Plast Surg, 1993, 31(2):175-180.
16.	Lu JC, Zelken J, Hsu CC, et al. Algorithmic approach to anterolateral thigh flaps lacking suitable perforators in lower extremity reconstruction. Plast Reconstr Surg, 2015, 135(5):1476-1485.
17.	Cigna E, Chen HC, Ozkan O, et al. The anteromedial thigh free flap anatomy:a clinical, anatomical, and cadaveric study. Plast Reconstr Surg, 2014, 133(2):420-429.
18.	Cormack GC, Lamberty BG. The blood supply to the skin by regions//The Arterial Anatomy of Skin Flaps. 2nd ed. Edinburgh:Churchill Livingstone, 1994:131-276.
19.	Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap:the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2):571-577.
20.	Rozen WM, Grinsell D, Koshima I, et al. Dominance between angiosome and perforator territories:a new anatomical model for the design of perforator flaps. J Reconstr Microsurg, 2010, 26(8):539-545.
21.	Yu P, Selber J. Perforator patterns of the anteromedial thigh flap. Plast Reconstr Surg, 2011, 128(3):151e-157e.
22.	Komorowska-Timek E, Gurtner G, Lee GK. Supercharged reverse pedicle anterolateral thigh flap in reconstruction of a massive defect:a case report. Microsurgery, 2010, 30(5):397-400.
23.	Kim IK, Kim TG, Lee JH, et al. The clinical course of reverse-flow anterolateral thigh flap:need to prepare for venous congestion and salvage operation. Arch Plast Surg, 2012, 39(3):262-264.
24.	Lin CH, Zelken J, Hsu CC, et al. The distally based, venous supercharged anterolateral thigh flap. Microsurgery, 2016, 36(1):20-28.

1. Song YG, Chen GZ, Song YL. The flap thigh flap:a new free flap concept based on the septocutaneous artery. Br J Plast Surg, 1984, 37(2):149-159.
2. Koshima I, Hosoda M, Inagawa K, et al. Free medial thigh perforator-based flaps:new definition of the pedicle vessels and versatile application. Ann Plast Surg, 1996, 37(5):507-515.
3. Cömert A, Altun S, Unlü RE, et al. Perforating arteries of the anteromedial aspect of the thigh:an anatomical study regarding anteromedial thigh flap. Surg Radiol Anat, 2011, 33(3):241-247.
4. Baek SM. Two new cutaneous free flaps:the medial and lateral thigh flaps. Plast Reconstr Surg, 1983, 71(3):354-365.
5. Yu P. Inverse relationship of the anterolateral and anteromedial thigh flap perforator anatomy. J Reconstr Microsurg, 2014, 30(7):463-468.
6. Xu DC, Zhong SZ, Kong JM, et al. Applied anatomy of the anterolateral femoral flap. Plast Reconstr Surg, 1988, 82(2):305-310.
7. Wong CH, Wei FC. Anterolateral thigh flap. Head Neck, 2010, 32(4):529-540.
8. 张功林, 葛宝丰, 姜世平, 等.逆行股前外侧岛状皮瓣和肌皮瓣移植术.中华医学杂志, 1990, 70(12):676-678.
9. Visconti G, Salgarello M, Visconti E, et al. Anatomy of anteromedial thigh perforators:CT-angiography study. Microsurgery, 2015, 35(3):196-203.
10. Koshima I, Soeda S, Yamasaki M, et al. The free or pedicled anteromedial thigh flap. Ann Plast Surg, 1988, 21(5):489-485.
11. Ao M, Uno K, Maeta M, et al. De-epithelialised anterior (anterolateral and anteromedial) thigh flaps for dead space filling and contour correction in head and neck reconstruction. Br J Plast Surg, 1999, 52(4):261-267.
12. Jia YC, Chen HH, Kang QL, et al. Combined anterolateral thigh and anteromedial thigh flap for extensive extremity reconstruction:vascular anatomy and clinical application. J Reconstr Microsurg, 2015, 31(9):674-680.
13. Yu P, Selber J, Liu J. Reciprocal dominance of the anterolateral and anteromedial thigh flap perforator anatomy. Ann Plast Surg, 2013, 70(6):714-716.
14. Xu ZF, Sun CF, Duan WY, et al. Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck. Br J Oral Maxillofac Surg, 2013, 51(8):725-730.
15. Koshima I, Hosoda M, Moriguchi T, et al. A combined anterolateral thigh flap, anteromedial thigh flap, and vascularized iliac bone graft for a full-thickness defect of the mental region. Ann Plast Surg, 1993, 31(2):175-180.
16. Lu JC, Zelken J, Hsu CC, et al. Algorithmic approach to anterolateral thigh flaps lacking suitable perforators in lower extremity reconstruction. Plast Reconstr Surg, 2015, 135(5):1476-1485.
17. Cigna E, Chen HC, Ozkan O, et al. The anteromedial thigh free flap anatomy:a clinical, anatomical, and cadaveric study. Plast Reconstr Surg, 2014, 133(2):420-429.
18. Cormack GC, Lamberty BG. The blood supply to the skin by regions//The Arterial Anatomy of Skin Flaps. 2nd ed. Edinburgh:Churchill Livingstone, 1994:131-276.
19. Wong CH, Wei FC, Fu B, et al. Alternative vascular pedicle of the anterolateral thigh flap:the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg, 2009, 123(2):571-577.
20. Rozen WM, Grinsell D, Koshima I, et al. Dominance between angiosome and perforator territories:a new anatomical model for the design of perforator flaps. J Reconstr Microsurg, 2010, 26(8):539-545.
21. Yu P, Selber J. Perforator patterns of the anteromedial thigh flap. Plast Reconstr Surg, 2011, 128(3):151e-157e.
22. Komorowska-Timek E, Gurtner G, Lee GK. Supercharged reverse pedicle anterolateral thigh flap in reconstruction of a massive defect:a case report. Microsurgery, 2010, 30(5):397-400.
23. Kim IK, Kim TG, Lee JH, et al. The clinical course of reverse-flow anterolateral thigh flap:need to prepare for venous congestion and salvage operation. Arch Plast Surg, 2012, 39(3):262-264.
24. Lin CH, Zelken J, Hsu CC, et al. The distally based, venous supercharged anterolateral thigh flap. Microsurgery, 2016, 36(1):20-28.

Chinese Journal of Reparative and Reconstructive Surgery

DESIGN AND CLINICAL APPLICATIONS OF DISTALLY BASED ANTEROMEDIAL THIGH FLAPS PEDICLED WITH PERFORATING VESSELS FROM RECTUS FEMORIS BRANCH

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