AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Four Dimensional CT-Scan Analysis of the Anterolateral Thigh Flap Perforator Branching Pattern
Institution where the work was prepared: UT Southwestern Medical Center, Dallas, TX, USA
Michel Saint-Cyr, MD1; Gary Arbique, PhD1; Jean Gao, PhD2; Dan Hatef, MD1; Spencer Brown, PhD1; Rod Rohrich, MD1; (1)UT Southwestern Medical Center at Dallas,
(2)University of Texas, Arlington
Introduction:
The vast majority of ALT flap anatomical vascular studies in the past have utilized lead oxide injections followed by 2-dimension radiography to determine
vascular territories. Although lead oxide treated specimens provide excellent images, limitations of this methodology are well known. Three-dimension radiography
can provide not only qualitative data on vascular anatomy, but also information on the direction and location of blood flow within each layer of a perforator
flap. Indeed to date, no studies have examined three and four dimensional vascular anatomies of the anterolateral thigh flap
Purpose:
The goals of this study were two fold. First, to assess the static and dynamic vascular anatomy and branching pattern of the ALT perforator unit and secondly,
to establish a new comprehensive system of classifying the vascular branching patterns of the ALT perforator complex.
Materials and Methods:
Ten fresh cadaver ALT flaps were dissected suprafascially, based on the largest perforator originating from descending branch of the lateral femoral cutaneous
artery. We then performed dynamic and static CT scans of all ALT flaps using a GE Light Speed 16 slice scanner. For dynamic scans, a slow injection using a
Harvard pump was used to introduce of 5 ml iodinated contrast agent over a 10 min period. During the injection, helical scans were repeated at intervals to
volume image the time evolution of flap vascularity. Scans were performed at 80 kVp when using iodinated contrast agent to optimize contrast, and 120 kVp
was used for lead oxide contrast to minimized beam hardening artifact.
Results:
The main ALT perforator originated from the descending branch of the lateral femoral cutaneous artery in all flap dissections and nine of ten perforators were
of the musculocutaneous variety. The ALT perforator unit vascular branching pattern was found to be highly variable and condensed throughout all layers of
the flap with numerous vertical, oblique and horizontal vascular interconnections. Vascular communications between the fascial, adipose and dermal layers of
the flap were observed up to the periphery of the flap in all cases and were maximized within a 5 cm radius of the perforator entry within the flap.
Conclusion:
The ALT perforator unit branching pattern consists of a highly condensed network of direct and indirect branches linking the fascial, adipose and cutaneous components
of the flap. This in turn provides additional insight in the possibility of safely harvesting large multi-component ALT flaps based on a single perforator.
The Supero-lateral Leg (SLL) Flap: an Anatomical Study and Clinical Applications
Institution where the work was prepared: University of Sao Paulo, Sao Paulo, Brazil
hsiang wei Teng; Luciano Ruiz Torres; arnaldo valdir zumiotti; University of Sao Paulo
The author performed an anatomical study of the proximal and lateral aspect of the leg, consisting of cadaver dissection, arteriogram and Doppler mapping,
in order to disclose the features of a new vessel, denominated superior peroneal artery. It originates from the tibiofibular trunk in 70 % of times, from the peroneal
artery, 20%, and from the anterior tibial artery, 10%. It contributes to nourish the soleous and the lateral gastrocnemius muscle. The superior peroneal
vessels are also suitable for microanastomosis. Therefore, the flap derived from the superior peroneal artery, called superolateral leg flap (SLL), was used for
lower leg reconstructions in 10 patients, in two of them as chimeric flap for complex tridimensional defects, with good results.
Clinica Application of the Free Microdissected Thin Groin Flap
Institution where the work was prepared: Fujigaoka Hospital, Showa University School of Medicine, Yokohama, Kanagawa, Japan
Naohiro Kimura, MD, PhD; Fujigaoka Hospital, Showa University School of Medicine
A free thin flap is a very convenient tool for reconstructive surgery, especially for the reconstruction of the extremities and treatment for burn scar contracture. In
2000, I developed a new method of preparing a thin flap by a microdissection, which represents intra-adiopsal dissection of the perforator vessel under operative
microscopic magnification. Through this procedure, four kinds of thin perforator flaps could have been elevated accurately in a single step procedure: microdissected
thin anterolateral thigh perforator flap, tensor fasciae latae perforator flap, deep inferior epigastric artery perforator flap, and thoracodorsal artery perforator
flap. Furthermore, I have applied the microdissection technique to the groin flap and succeeded in elevating microdissected thin groin flaps. From October of
2002 to March of 2006, 21 patients underwent reconstruction with microdissected thin groin flaps. In the preparation of the flap, the perforator penetrating the
fascia of the sartorius muscle is initially detected suprafascially, and then the deep adipose and subfascia layer of the inguinal area is dissected using an operative
microscope. After confirming the distribution of the blood vessels in this area, the flap was elevated while dissecting between the deep and superficial adipose layer.
The flaps ranged from 8 to 22 cm in length and from 5 to 14 cm in width. Major complications were not observed except for postoperative venous thrombosis in
one case, and the deep branch was absent in another case. Necrosis in a small part of the flap occurred in three cases. Other transfers were uneventful. The average
length of the pedicle was approximately 7 cm. There were some report of modification in groin flap elevation, the trial for thinning of the whole flap was far
from successful, because the massive adipose tissue around the pedicle was left intact. However, the use of microdissection has allowed the buried vessel in the
adipose tissue to be used as a pedicle of the flap, and to transfer a uniformly thin groin flap without excess fat mass.
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