Is the Oblique Branch a Preferable Vascular Pedicle for Anterolateral Thigh Free Flaps?

Deng, Chao; Nie, Kaiyu; Wei, Zairong; Jin, Wenhu; Li, Hai; Li, Shujun; Wu, Bihua; Wang, Dali

doi:10.1055/s-0038-1639370

Cited by 14 publications

(15 citation statements)

References 29 publications

(34 reference statements)

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“…23 While the oblique branch typically has a smaller vessel diameter and shorter pedicle length relative to the D-LCFA, its higher incidence of a septocutaneous course makes it preferable in certain situations due to an easier and quicker dissection. 24,25 Furthermore, it offers the additional advantage of being able to be raised as a single or multipaddle flap depending on recipient needs. 24,25 In a minority of cases, the oblique branch may be the only skin perforator, necessitating its preservation.…”

Section: Discussionmentioning

confidence: 99%

“…24,25 Furthermore, it offers the additional advantage of being able to be raised as a single or multipaddle flap depending on recipient needs. 24,25 In a minority of cases, the oblique branch may be the only skin perforator, necessitating its preservation. In addition to different pedicles, varying pedicle branching patterns have been described.…”

Section: Discussionmentioning

confidence: 99%

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Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Cohen

Abdou

Nolan

et al. 2020

J Reconstr Microsurg

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Abstract Background The anterolateral thigh (ALT) flap is a useful flap with minimal donor site morbidity. Preoperative computed tomographic angiography (CTA) for lower extremity reconstruction can determine vessel integrity and plan for recipient vascular targets. This study reviews lower extremity CTAs to further characterize ALT vascular anatomy and associated clinical implications thereof. Patients and Methods Lower extremity CTA studies were retrospectively reviewed, and information on ALT cutaneous perforator location, origin, and course was collected. Results A total of 58 lateral circumflex femoral artery (LCFA) systems in 31 patients were included. Average age was 38.8 ± 15.9 years with mean body mass index of 27.2 ± 5.7 kg/m2. The majority of patients were females (23, 74.2%). The LCFA most commonly originated from the profunda femoris artery (87.3%), followed by the distal common femoral artery (9.1%). On average, there were 1.66 ± 0.69 cm perforators per extremity, with an average of 5.38 cm between adjacent perforators. Perforators originated from the descending branch of the LCFA in 89.6% of studies. Perforator caliber was <1 mm (29, 30.2%), 1 to 2 mm (55, 57.3%), or >2 mm (12, 12.5%). Mean distance from the most proximal perforator to the anterior superior iliac spine was 20.4 ± 4.82 cm. Perforators were musculocutaneous (46.9%), septocutaneous (34.4%), or septomyocutaneous (18.8%). In 58.1% of patients, only one thigh had easily dissectable septocutaneous and/or septomyocutaneous perforators, in which case preoperative CTA aided in donor thigh selection. Conclusion ALT flap cutaneous perforator anatomy varies considerably. Using CTA, we report on rates of septocutaneous, myocutaneous, and septomyocutaneous perforators and underscore its utility in perforator selection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Cohen

Abdou

Nolan

et al. 2020

J Reconstr Microsurg

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“…The majority of thighs (15) showed multiple perforators. An oblique branch 20,21 of the lateral circumflex femoral artery gave perforators in five thighs (25%). In one thigh, the oblique branch gave two perforators, for a total of six (11.8%) perforators arising from the oblique branch.…”

Section: Resultsmentioning

confidence: 99%

“…Such variation would be clinically relevant as recent work has recommended the oblique branch (if present) over the descending branch as a pedicle for the ALT flap. 20 Deng et al found that oblique branches were present in 34% of cases (echoing the 35% in Wong et al's initial description) and, when used as flap pedicles, yielded significantly more septocutaneous perforators, significantly shorter operating times and similar operative results when compared with the descending branch. As such, trainees may be encouraged to explore the oblique branch more readily and thus could be aided by a clearer description of any variations in BxJn anatomy specific to this branch.…”

Section: Furthermore Some Box Junctions May Require Sacrifice Of Thementioning

confidence: 90%

Neurovascular Anatomy at the “Box Junction”: Considerations in the Anterolateral Thigh Flap

Stewart

Brassett

Abood

2018

J reconstr Microsurg

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“…Wong et al confirmed that there are two variants of anatomical vascularisation of the ALT lobe in their study describing the exact anatomy of the vascular pedicle of ALT [ 12 ]. In most cases, the blood supply comes from the descending branch of the femoral artery; however, less commonly, the blood supply comes from the oblique branch of the circumflex artery [ 13 ]. In the present study, most of the flaps (> 97%) were vascularised through the descending branch.…”

Section: Discussionmentioning

confidence: 99%

Colour Doppler sonography in the preoperative assessment of the vascular pedicle from the anterolateral thigh flap: proposal for a mathematical formula to predict pedicle length

Łuczewski

Machczyński

Marszałek

et al. 2018

Eur Arch Otorhinolaryngol

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IntroductionThe anterolateral thigh flap (ALT) is one of the most commonly used grafts in head and neck reconstructive surgery. In this type of surgery, it is essential that the vascular pedicle be long enough to ensure proper vascular anastomosis. However, it is difficult to accurately estimate the pedicle length preoperatively. In this context, the current study had two aims: (1) to assess the value of colour Doppler sonography (CDS) in the preoperative assessment of the vascular pedicle and (2) to develop a mathematical model to predict the length of the vascular pedicle based on the ultrasound findings.Materials and methodsRetrospective review of patients who underwent primary surgery for head and neck cancer followed by ALT flap reconstruction at our institution from 2014 to 2018. All patients underwent CDS prior to surgical excision of the flap.ResultsPreoperative CDS was useful to identify the location of the vascular perforators, to estimate the pedicle length, and to identify the vascularization variant. Using the proposed mathematical formula, the estimated minimum pedicle length and actual length agreed in 73.9% of cases, increasing to 84.1% when a 5 mm margin of error was allowed. Moreover, preoperative ultrasound accurately distinguished the two anatomical variants of the ALT vasculature in nearly all cases (97.1%).ConclusionThis study confirms the value of preoperative colour Doppler sonography for ALT flap reconstruction. The proposed mathematical model provides a highly accurate method of preoperatively assessing the length of the vascular pedicle, which may be of value in head and neck surgery.

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Is the Oblique Branch a Preferable Vascular Pedicle for Anterolateral Thigh Free Flaps?

Abstract: The oblique branch is sufficiently large and can be reliably used as the flap pedicle. It may be the preferred vascular pedicle for ALT free flaps.

Cited by 14 publications

References 29 publications

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Neurovascular Anatomy at the “Box Junction”: Considerations in the Anterolateral Thigh Flap

Colour Doppler sonography in the preoperative assessment of the vascular pedicle from the anterolateral thigh flap: proposal for a mathematical formula to predict pedicle length

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