Distal anastomosis patterns of the descending branch of the lateral circumflex femoral artery

Boonrod, Arunnit; Thammaroj, Tala; Jianmongkol, Surut; Prajaney, Parichat

doi:10.3109/2000656x.2015.1137927

Cited by 8 publications

(15 citation statements)

References 10 publications

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“…The typical pattern for DAT occurs when it branches off the LCFA, which in turn branches off the PFA. This was observed in 62.75% of limbs in the present study; these results align with the majority of previous studies that have found this pattern to be present in 74%-82% of limbs analyzed (Pan et al 2004;Boonrod et al 2016).…”

Section: Discussionsupporting

confidence: 93%

“…In contrast, a study from Taiwan of 11 limbs found this typical branching pattern in 82% of limbs (Pan et al 2004). Similarly, a study from Thailand of 50 limbs observed the typical branching pattern in 80% of dissected limbs (Boonrod et al 2016), while a Japanese study of 70 limbs reported the typical branching pattern in 74% of the limbs studied (Kimata et al 1998). An angiogram review study conducted in Thailand analyzing 194 lower limbs also observed this pattern in 79% of limbs (Burusapat et al 2016).…”

Section: Introductionmentioning

confidence: 84%

“…In addition to its inconstant source, the presence of an anastomosis between the DAT and the SLGA to provide collateral circulation in the lower limb is also variable, with studies indicating anastomosis within a range of approximately 80% of limbs (Fathi et al 2008;Sabalbal et al 2013) to only 46% of limbs (Boonrod et al 2016). Moreover, a Dutch study of 10 limbs found that 61% of collateral vessels originated from the PFA, and 57% of those also anastomosed with the SFA (Kruse et al 2017).…”

Section: Introductionmentioning

confidence: 99%

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Collateral circulation of the femoral and genicular systems in human lower limbs is highly uncommon

et al. 2020

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The descending branch of the lateral circumflex artery is a septocutaneous vessel that is vital for free and pedicle thigh flap transfer surgeries when repairing tissue defects. It also forms an anastomosis with the superior lateral genicular artery to create a collateral pathway for circumventing occlusions in the superficial femoral artery (SFA). Many anatomical texts and atlases imply the persistence of this anastomosis. However, previous studies indicate variability in the source of the arteries that form the anastomosis, and have reported cases where an anastomosis does not exist. We hypothesized that variations from the conventional accepted pattern can be predicted by comparisons of arterial diameters, and that unconventional anastomoses may be present to facilitate collateral circulation to the limb. Fifty‐one limbs were dissected and analyzed to establish the source of the descending branch of the lateral circumflex artery, classify the types of anastomoses, and compare the diameters of the descending branch of the lateral circumflex artery, the SFA and the profunda femoris artery to the common femoral artery (CFA). Vessel diameters were normalized to the diameter of the CFA to allow comparison of limbs from both sexes and to minimize the effects of cadaver size on correlating vessel size to the presence or absence of collateral circuits. We report that 62.7% of limbs (32/51) had typical branching patterns; however, only 27.4% of limbs (14/51) had any anastomosis to connect the proximal and distal regions of the thigh. Importantly, the SFA had a wider relative diameter in limbs without anastomoses than in limbs that had normal anastomoses, perhaps precluding the formation of a collateral pathway. Overall, collateral circulation of the lower limb was highly uncommon, in contrast to information inferred from anatomical texts. This study suggests the need for more thorough procedures for determining viable anastomoses prior to thigh flap surgeries to ensure flap survival.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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Collateral circulation of the femoral and genicular systems in human lower limbs is highly uncommon

et al. 2020

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“…The SLGA subdivides into an anterior (also named superficial or patellar) and a posterior (also named deep or condylar) branch, and is responsible for the blood supply to the lateral femoral condyle, the lateral head of the gastrocnemius muscle, the vastus lateralis muscle and the biceps femoris muscle (Kirschner ). Furthermore, the iliotibial tract and the overlying skin at the superolateral side of the knee are supplied by the SGLA (Laitung, 1989;Hayashi & Maruyama, 1990b;Zhang, 1990;Pan et al 2004;Fathi et al 2008;Pan & Taylor, 2009;Nguyen et al 2011;Boonrod et al 2016;Parvizi et al 2016;Morsy et al 2018). Apart from the DGA, the SLGA was the artery most often identified in this study.…”

Section: Slgamentioning

confidence: 57%

“…Information on the morphology of the artery may be frequently found (Walton & Bunkis, 1984;Hayashi & Maruyama, 1990b;Kirschner et al 1998;Wong et al 2015;Morsy et al 2018). Also the supplied profound structures and the location of the respective skin areas were described (Laitung, 1989;Hayashi & Maruyama, 1990b;Zhang, 1990;Pan et al 2004;Fathi et al 2008;Pan & Taylor, 2009;Nguyen et al 2011;Boonrod et al 2016;Parvizi et al 2016;Morsy et al 2018), but data on the respective size of the perforator angiosomes are hitherto lacking.…”

Section: Introductionmentioning

confidence: 99%

Vascular coverage of the anterior knee region – an anatomical study

2019

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Descriptions of vessel angiosomes or perforasomes throughout the human body are quite frequent, and led to the development of flaps nowadays commonly used to surgically cover skin and soft tissue defects. In these procedures, the surgeon requires a profound anatomical knowledge of the respective blood vessels and the extent of the perfused area to define the size of the graft. In the region of the knee joint, descriptions of flaps based on the superior lateral genicular artery and descending genicular artery are quite frequent. In contrast, information regarding other popliteal branches is scarce or non‐existent. The aim of this study was to provide a concise and complete overview on the extent and variability of the perforator angiosomes of the femoral and popliteal arteries in the anterior knee region. Twenty lower extremities were dissected, the respective perforators identified and perfused with dye. All resulting angiosomes were marked and documented. A total of 84 angiosomes were identified in all specimens, with an average of 4.2 (3–6) angiosomes per specimen. The average size of the angiosomes was 97.04 ± 72.30 cm 2 (8.61–360.41 cm 2 ), their source vessels had an average diameter of 1.42 ± 0.54 mm (0.60–3.25 mm). The complex and highly variable distribution of perforator angiosomes of the anterior knee region and especially of its less frequently investigated distal part was demonstrated. Based on these results, the planning of existing perforator flaps in this region and the development of flaps including the inferior medial or inferior lateral genicular arteries may be facilitated.

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“Reverse tensor fascia latae perforator flap for reconstruction of knee defect: Anatomic study by computed tomographic angiography and a case report”

et al. 2022

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Background Reverse anterolateral thigh perforator (ALTp) pedicle flap can be used to reconstruct perigenicular defect thanks to the anastomoses between the descending branch of the lateral circumflex femoral artery (LCFA) and the perigenicular network. In a few cases, however, patients do not present any ALTp. We hypothesized that, in such cases, an adjacent perforator, the tensor fascia latae perforator (TFLp), emerging from the LCFA ascending branch, could be used instead. To assess the feasibility of this technique, a radiological study was conducted. A first patient was treated using this option. Methods Sixty lower limb computed tomography were analyzed. The first treated patient was a 50‐years‐old man suffering from a 5‐mm chronic bone exposure and osteomyelitis. Other reconstructive options were not indicated since he presented a multiscarry leg, severe arteriopathy, and no ALTp. A TFLp flap was raised, and the LCFA ascending and descending branches were dissected in continuity. After ligation of the LCFA, the blood flow reversed in the descending branch to irrigate the flap through the ascending branch. Results A TFL perforator was observed in all the cases of the radiological study. The LCFA branching pattern was compatible with achieving a reverse TFL perforator flap in 43 cases (72%). The average pedicle length was 32 cm (22–38 cm). In the first clinical case, the flap covered the defect easily. After three months, the patient showed no evidence of infection recurrence and recovered a painless walk. Conclusion The reverse TFLp flap can be a suitable option for perigenicular reconstruction.

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Distal anastomosis patterns of the descending branch of the lateral circumflex femoral artery

Cited by 8 publications

References 10 publications

Collateral circulation of the femoral and genicular systems in human lower limbs is highly uncommon

Collateral circulation of the femoral and genicular systems in human lower limbs is highly uncommon

Vascular coverage of the anterior knee region – an anatomical study

“Reverse tensor fascia latae perforator flap for reconstruction of knee defect: Anatomic study by computed tomographic angiography and a case report”

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