Individually tailored approach to reconstruction of complex defects using versatility of the lateral circumflex femoral artery system-based pedicled flaps

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2022-01, Vol.75 (1), p.199-209
• Main Authors: Acartürk, Tahsin Oğuz, Bengür, Fuat Barış
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; anterolateral thigh flap; Child; Child, Preschool; Female; Femoral Artery - surgery; Humans; lateral circumflex femoral artery; Male; Middle Aged; Myocutaneous Flap; pedicled flaps; Perforator Flap - blood supply; Reconstructive Surgical Procedures; rectus femoris; Skin Transplantation; Soft Tissue Injuries - surgery; Thigh - surgery; vastus lateralis; Young Adult
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2021.08.035

Lateral circumflex femoral artery (LCFA) system is one of the most versatile donor sites in the body. We present our experience with pedicled flaps from the LCFA system, including different components for a wide variety of etiologies and locations. Twenty-three consecutive pedicled flaps were performed on 22 patients (10 females and 12 males; age 4–71 years) between 2007 and 2015 by a single surgeon. Flap size, type, and composition were tailored according to the requirements of the defects, including (1) location; (2) surface area; (3) depth; (4) number of defects; (5) presence of exposed critical structures; (6) presence of exposed foreign bodies; (7) prior use of other options; (8) history of radiation; and (9) other comorbidities. Defect locations were 10 abdominal wall (including groin and pubis), 9 ischio-gluteo-trochanteric and 4 perineal. Defect sizes ranged from 6 × 6 to 30 × 35 cm. Maximum depth of wounds ranged between 7 and 18 cm. The flap sizes ranged from 9 × 6 to 38 × 20 cm. Two flaps were fasciocutaneous perforator, 4 were myocutaneous with “muscle sparing” vastus lateralis, 10 were myocutaneous with “segmental” vastus lateralis, 5 were myocutaneous “tri-muscle,” 1 was “tri-muscle,” and 1 was rectus femoris only. Donor sites were closed primarily in 20 cases and with split thickness skin grafting in 3 cases. All flaps survived completely without any partial loss or congestion. Pedicled flaps from the LCFA system can be tailored individually for a wide variety of etiologies and locations. Muscles can be harvested and used as “muscle sparing,” “segmental,” and “tri-muscle” to accommodate the requirements of the defects.