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DOI: 10.1055/s-0030-1249321
The Ascending Branch of the Lateral Circumflex Femoral Vessels: Review of the Anatomy and its Utilization as Recipient Vessel for Free-Flap Reconstruction of the Hip Region
Publication History
Publication Date:
24 February 2010 (online)
ABSTRACT
The ascending branch of the lateral circumflex artery may be of potential value as an alternative recipient vessel in the free-flap transfer to hip region. The anatomy of the ascending branch of the lateral circumflex femoral vessels has been reviewed with regards to size, location, and length and on the basis of previous anatomical and clinical studies in the literature. Surgical exposure of the ascending branch has been described. The ascending vessels were used suitably in the free-flap reconstruction of the hip wounds in two case examples. The ascending vessels follow an oblique course behind the rectus femoris muscle to reach the hilus of tensor fascia latae muscle, laterally and superiorly. The vessels are located at distance 7–12 cm from the anterior superior iliac spine in the interval between the rectus femoris and tensor fascia latae muscles. External diameter of the artery varies between 2 and 3 mm, which is usually accompanied by two venae comitantes measuring 1.8 to 2.5 mm. The ascending branch has a predictable location, a consistent anatomy, and an adequate caliber. Its surgical exposure is relatively easy. It should be placed in the armamentarium of recipient vessels as an alternative particularly in the free-flap reconstruction of the hip region.
KEYWORDS
Ascending branch - lateral circumflex femoral vessels - free flap - hip wound - reconstruction
REFERENCES
- 1 Meland N B, Arnold P G, Weiss H C. Management of the recalcitrant total-hip arthroplasty wound. Plast Reconstr Surg. 1991; 88 681-685
- 2 Windle B H, Stroup Jr R T, Beckenstein M S. The inferiorly based rectus abdominis island flap for the treatment of complex hip wounds. Plast Reconstr Surg. 1996; 98 99-102
- 3 Schmidt A B, Fromberg G, Ruidisch M H. Applications of the pedicled vastus lateralis flap for patients with complicated pressure sores. Spinal Cord. 1997; 35 437-442
- 4 Erçöçen A R, Apaydin I, Emiroğlu M et al.. Island V-Y tensor fasciae latae fasciocutaneous flap for coverage of trochanteric pressure sores. Plast Reconstr Surg. 1998; 102 1524-1531
- 5 Huang K C, Peng K T, Li Y Y, Tsai Y H, Huang T J, Hsu R W. Modified vastus lateralis flap in treating a difficult hip infection. J Trauma. 2005; 59 665-671
- 6 Ishida L H, Munhoz A M, Montag E et al.. Tensor fasciae latae perforator flap: minimizing donor-site morbidity in the treatment of trochanteric pressure sores. Plast Reconstr Surg. 2005; 116 1346-1352
- 7 Jósvay J, Sashegyi M, Kelemen P, Donáth A. Modified tensor fascia lata musculofasciocutaneous flap for the coverage of trochanteric pressure sores. J Plast Reconstr Aesthet Surg. 2006; 59 137-141
- 8 Küntscher M V, Mansouri S, Noack N, Hartmann B. Versatility of vertical rectus abdominis musculocutaneous flaps. Microsurgery. 2006; 26 363-369
- 9 Tzeng Y S, Yu C C, Chou T D, Chen T M, Chen S G. Proximal pedicled anterolateral thigh flap for reconstruction of trochanteric defect. Ann Plast Surg. 2008; 61 79-82
- 10 Park S, Koh K S. Superior gluteal vessel as recipient for free flap reconstruction of lumbosacral defect. Plast Reconstr Surg. 1998; 101 1842-1849
- 11 Park S. Muscle-splitting approach to superior and inferior gluteal vessels: versatile source of recipient vessels for free-tissue transfer to sacral, gluteal, and ischial regions. Plast Reconstr Surg. 2000; 106 81-86
- 12 Hill H L, Nahai F, Vasconez L O. The tensor fascia lata myocutaneous free flap. Plast Reconstr Surg. 1978; 61 517-522
-
13 Strauch B, Yu H L, Chen Z W, Liebling R.
Tensor fascia lata flap . In: Strauch B, Yu HL, Chen ZW, Liebling R Atlas of Microvascular Surgery. New York; Thieme Medical Publishers 1993: 174-176 - 14 Bulstrode N W, Kotronakis I, Baldwin M AR. Free tensor fasciae latae musculofasciocutaneous flap in reconstructive surgery: a series of 85 cases. J Plast Reconstr Aesthet Surg. 2006; 59 130-136
- 15 Nahai F. The tensor fascia lata flap. Clin Plast Surg. 1980; 7 51-56
- 16 Hill H L, Nahai F, Vasconez L O. The tensor fascia lata myocutaneous free flap. Plast Reconstr Surg. 1978; 61 517-522
- 17 Williams PL, Warwick R, Dyson M, Bannister LH Angiology. In: Gray’s Anatomy. 37th ed. New York; Churchill Livingstone 1989: 783
-
18 Kimura N.
Lateral circumflex femoral artery-tensor fascia lata perforator flap . In Blondeel PN, Morris SF, Hallock GG, Neligan PC Perforator Flaps: Anatomy, Technique, & Clinical Applications. St. Louis; Quality Medical Publishing 2006: 617-633 - 19 Saadeh F A, Haikal F A, Abdel-Hamid F A. Blood supply of the tensor fasciae latae muscle. Clin Anat. 1998; 11 236-238
- 20 Little III J W, Lyons J R. The gluteus medius-tensor fasciae latae flap. Plast Reconstr Surg. 1983; 71 366-371
- 21 Cormack G C, Lamberty B GH. The arterial anatomy of skin flaps, 2nd ed. New York; Churchill Livingstone 1994: 236-237
-
22 Stevenson T R, Nahai F.
Tensor fascia latae musculocutaneous flap . In: Strauch B, Vasconez LO, Hall-Findlay EJ Grabb’s Encyclopedia of Flaps. ed. vol 3. Boston; Little Brown and Company 1990: 1594-1597 -
23 Serafin D.
The tensor fasciae lataee muscle-musculocutaneous flap . In: Serafin D Atlas of Microsurgical Composite Tissue Transplantation. Philadelphia; W.B. Saunders Company, Donald Serafin 1996: 271-281 - 24 Swenson T M, Urbaniak J R, Sotereanos D G. A surgical guide for identifying the lateral femoral circumflex vessels during free vascularized fibular transfer for avascular necrosis of the femoral head. J Reconstr Microsurg. 1996; 12 1-4
- 25 Lindsey J T. Integrating the DIEP and muscle-sparing (MS-2) free TRAM techniques optimizes surgical outcomes: presentation of an algorithm for microsurgical breast reconstruction based on perforator anatomy. Plast Reconstr Surg. 2007; 119 18-27
- 26 Schoeller T, Huemer G M, Otto-Schoeller A, Wechselberger G. Correction of contour deformities of the hip region with a pedicled DIEP flap. Plast Reconstr Surg. 2007; 119 212-215
- 27 Xu D C, Kong J M, Zhong S Z. The ascending branch of the lateral circumflex femoral artery. A new supply for vascularized iliac transplantation. Surg Radiol Anat. 1989; 11 263-264
- 28 Marchant Jr M H, Zura R D, Urbaniak J R, Aldridge III J M. Hip incision planning for free vascularized fibular grafting of the proximal femur: a handy tip. J Surg Orthop Adv. 2007; 16 204-206
- 29 Hallock G G. The vascular pedicle of the anterolateral thigh flap as an alternative recipient site for thigh free flaps. J Reconstr Microsurg. 2008; 24 131-136
Raffi GurunluogluM.D. Ph.D.
Chief and Associate Professor, Plastic and Reconstructive Surgery
Denver Health Medical Center, 777 Bannock Street, Denver CO 80204
Email: raffi.gurunluoglu@dhha.org