Abstract
Background
Complex and extensive limb defects involve difficult reconstructive problems, and lateral circumflex femoral artery (LCFA) system flaps provide an adequate reconstructive answer for these challenging wounds.
Methods
A retrospective review on 50 patients treated with LCFA system flaps to cover lower extremity wounds was carried out. Data collected included age, gender, defect size, defect location, flap size, flap composition, anatomical findings, donor site closure, secondary procedures, and complications.
Results
The overall flap survival rate was 96 %. We performed three flap re-explorations with two subsequent failures. Four different combinations of tissues from LCFA system flaps were employed to restore defects produced by open fractures in tibia (16), severe crushing or avulsion injury (15), chronic posttraumatic osteomyelitis (13), and others (6). The mean size of the skin flap was 162.56 cm2 (range 54–312 cm2) and the volume of the muscle flap was 160 cm3 (range 44–250 cm3). Debulking procedures were performed in seven patients. Donor sites were closed primarily in all but five patients who required a skin graft.
Conclusions
The LCFA system is efficient and its use, versatility, and reliability in lower limb reconstruction have been proven. No other donor site in the body offers such a large amount of tissue with minimal donor morbidity.
Level of Evidence: Level IV, therapeutic study.
Similar content being viewed by others
References
Pu LL, Medalie DA, Rosemblum WJ, Rosenblum WJ, Lawrence SJ, Vasconez HC (2004) Free tissue transfer to a difficult wound of the lower extremity. Ann Plast Surg 53:222–228
Pollak AN, McCarthy ML, Burgess AR (2000) Short-term wound complications after application of flaps for coverage of traumatic soft-tissue defects about the tibia. J Bone Jt Surg 82-A:1681–1691
Yildirim S, Gideroglu K, Aköz T (2003) Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg 19:225–233
Özkan Ö, Coşkunfirat K, Özgentas E (2004) The use of free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities. Ann Plast Surg 53:455–461
Lin CH, Wei FC, Lin YT, Rodriguez EJ, Chen CT (2006) Lateral circumflex femoral artery system: warehouse for functional composite free-tissue reconstruction of the lower leg. J Trauma 60:1032–1036
Spyrionuis PK, Lutz BS (2008) Versatility of the free vastus lateralis muscle flap. J Trauma 64:1100–1105
Kuo Y-R, Yeh M-C, Shih H-S, Chen C-C, Lin P-Y, Chiang Y-C, Jeng S-F (2009) Versatility of the anterolateral thigh flap with vascularized fascia lata for reconstruction of complex soft-tissue defects: clinical experience and functional assessment of the donor site. Plast Reconstr Surg 124:171–180
Wong C-H, Ong Y-S, Wei F-C (2012) The anterolateral thigh-vastus lateralis conjoint flap for complex defects of the lower limb. J Plast Reconstr Aesthet Surg 65:235–239
Duymaz A, Karabekmez FE, Vrtiska TJ, Mardini S, Moran SL (2009) Free tissue transfer for lower extremity reconstruction: a study of the role of computed angiography in the planning of free tissue transfer in the post-traumatic setting. Plast Reconstr Surg 124:523–529
Wong C-H, Wei F-C (2010) Anterolateral thigh flap. Head Neck 32:529–540
Chen H-C, Tang Y-B (2003) Anterolateral thigh: an ideal soft tissue flap. Clin Plast Surg 30:383–401
Lin SJ, Rabie A, Yu P (2010) Designing the anterolateral thigh flap without preoperative Doppler or imaging. J Reconstr Microsurg 26:67–72
Yu P, Youssef A (2006) Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg 118:928–933
Hsieh C-H, Yang JC-S, Chen C-C, Kuo Y-R, Jeng S-F (2009) Alternative reconstructive choices for anterolateral thigh flap dissection in cases in which no sizable skin perforator is available. Head Neck 31:571–575
Yu P, Selber J (2011) Perforator patterns of the anteromedial thigh flap. Plast Reconstr Surg 128:151e–157e
Ribuffo D, Cigna E, Gargano F, Spalvieri C, Scuderi N (2005) The innervated anterolateral thigh flap: anatomical study and clinical implications. Plast Reconstr Surg 115:464–470
Lin Y-T, Wei F-C (2006) More degrees of freedom by using chimeric concept in the applications of the anterolateral thigh flap. J Plast Reconstr Surg 59:622–627
Cavadas PC, Sanz-Jimenez JR (2005) Use of extended-pedicle vastus lateralis free flap for lower extremity reconstruction. Plast Reconstr Surg 115:1070–1076
Akhtar S, Hameed A (2006) Versatility of the sural fasciocutaneous flap in the coverage of lower third leg and hind foot defects. J Plast Reconstr Aesthet Surg 59:839–845
Parret BM, Talbot SG, Pribaz JJ, Lee BT (2009) A review of local and regional flaps for distal leg reconstruction. J Reconstr Microsurg 25:445–455
Georgescu AV (2012) Propeller perforators flaps in distal lower leg: evolutions and clinical applications. Arch Plast Surg 39:94–105
Pu LLQ (2007) Soft-tissue reconstruction of an open tibial wound in the distal third of the leg. A new treatment algorithm. Ann Plast Surg 58:78–83
Lee JC, St-Hilare H, Christy MR, Wise MW, Rodríguez ED (2010) Anterolateral thigh flap for trauma reconstruction. Ann Plast Surg 64:164–168
Park JE, Rodríguez ED, Bluebond-Langer R, Bochicchio G, Christy MR, Bochicchio K, Scalea TM (2007) The anterolateral thigh flap is highly effective for reconstruction of complex lower extremity trauma. J Trauma 62:162–165
Yazar S, Lin C-H, Ulusal AE, Wei F-C (2006) Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle open tibial fractures. Plast Reconstr Surg 117:2648–2475
Koshima I, Yamamoto H, Hosodo M, Moriguchi T, Orita Y, Nagayama H (1993) Free combined composite flaps using the lateral circumflex femoral artery system for repair massive defects of the head and neck region: an introduction to chimeric flap principle. Plast Reconstr Surg 92:411–420
Kuo Y-R, An P-C, Kuo M-H, Kueh N-S, Yao S-F, Jeng S-F (2008) Reconstruction of knee joint soft tissue and patellar tendon defects using a composite anterolateral thigh flap with vascularized fascia lata. J Plast Reconstr Aesthet Surg 61:195–199
Houtmeyers P, Opsomer O, van Landuyt K, Monstrey S (2012) Reconstruction of the Achilles tendon and overlying soft tissue by composite anterolateral thigh flap with vascularized fascia lata. J Reconstr Microsurg 28:205–210
Kuo Y-R, Kuo M-H, Chou W-C, Liu Y-T, Lutz BS, Jeng S-F (2003) One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment. Ann Plast Surg 50:149–155
Lee MJ, Lee WJ (2012) Lower extremity reconstruction using vastus lateralis myocutanous flap versus anterolateral thigh fasciocutaneous flap. Arch Plast Surg 39:367–375
Yamamoto Y, Tsuneki S, Furuta Y, Fukuda S (1998) Functional reconstruction of the tongue and deglution muscles following extensive resection of tongue cancer. Plast Reconstr Surg 102:993–998
Posch NAS, Mureau MAM, Flood SJ, Hofer SOP (2005) The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects. Br J Plast Surg 58:1095–1103
Ghods M, Grabs M, Kersten C, Chatzopoulos PP, Geomelas M (2012) A modified free muscle transfer technique to effectively treat chronic and persistent calcaneal osteomyelitis. Ann Plast Surg 68:599–605
Paraskevi Askouni E, Topping A, Ball S, Hettiaratchy S, Nanchahal J, Jain A (2011) Outcomes of anterolateral thigh free flap thinning using liposuction following lower limb trauma. J Plast Reconstr Aesteth Surg 65:474–481
Hui-Chou H, Bluebond-Langner R, Rodríguez ED (2011) Secondary refinements of free perforators flaps for lower extremity reconstruction. Plast Reconstr Surg 127:248–257
Hong JP, Kim EK (2007) Sole reconstruction using anterolateral thigh perforator free flaps. Plast Reconstr Surg 119:186–193
Kimata Y, Uchiyama K, Ebihara S et al (2000) Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 106:584–589
Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K (1998) Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 102:1517–1523
Chen H-H, Lin M-S, Chou E-K, Chang SC-N (2009) Anterolateral thigh perforator flap: varying perforator anatomy. Ann Plast Surg 63:153–155
Zhang Q, Qiao Q, Gould LJ, Myers WT, Phillips LG (2008) Study of the neural and vascular anatomy of the anterolateral thigh flap. J Plast Reconstr Aesthet Surg 63:365–371
Wong C-W, Wei F-Ch FB, Chen Y-A, Lin J-Y (2009) Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg 123:571–577
Conflict of Interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Camporro, D., García, E. & Barrio, L. Versatility of the lateral circumflex femoral arterial (LCFA) system flaps for lower extremity soft tissue reconstruction. Eur J Plast Surg 36, 559–566 (2013). https://doi.org/10.1007/s00238-013-0847-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-013-0847-y