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.

BackgroundThe aim of this study was to define blood flow characteristics of multiple types of flaps and the theoretical basis of flap axis design.Material/MethodsSixty Sprague-Dawley (SD) rats were randomly divided into 6 groups: a normal skin group, and 5 groups with different types of flap: abdominal flap group, dorsal flap group, single-perforator flap group, double-perforators flap group, and delayed cutaneous nerve flap group. The vascular distribution characteristics of normal skin and various flap types were observed by gross morphology of specimens and X-ray after perfusion.ResultsThere were distinct differences in vascular anastomosis and density in dorsal and ventral SD rats. The area of flap survival in the dorsal flap group was superior to that in the abdominal flap group, but the flap axis of the 2 groups passed straight through the middle of the pedicle. The flap surviving area in the double-perforators flap group was remarkably larger than in the single-perforator flap group, while the flap axis in the single-perforator flap group passed straight through the perforators, and in the double-perforators flap group there was a linking vessel between the 2 perforators. There were linking and reticulate vessels, in addition, linking vessels and cutaneous nerves were concomitant in the delayed cutaneous nerve flap group. The flap axis was the travel route of the cutaneous nerve.ConclusionsVariations in flap blood supply patterns and axes with alterations based on flap types have implications for flap survival. Understanding blood flow characteristics within each flap type and accurately designing the flap axis is essential for flap survival.

Rationale:Reducing the morbidity associated with anterolateral thigh (ALT) donor sites by performing aesthetic restoration has become a popular research topic. Various surgical techniques have been developed allowing for direct closure of the donor site. However, closure techniques for ALT donor sites based on the oblique branch have not been systematically reported.Patient concerns:Data from 21 patients (18 males, 3 females) undergoing operative reconstruction with an ALT free flap between January 2016 and December 2016. The mean age of the participants was 42 years (range, 18–60 years).Diagnoses:The soft-tissue defects resulted from a traffic accident in 9 patients, a fall injury in 7 patients, a machinery injury in 3 patients, an electrical injury in 1 patient, and a burn scar in 1 patient. The wound areas ranged from 6 × 3.5 to 28 cm × 10 cm.Interventions:Several surgical techniques, including the split skin paddle technique and utilization of an adjacent perforator flap or an ipsilateral groin flap, were utilized to facilitate direct closure of the ALT flap donor site.Outcomes:Of the 21 patients included in the study, the donor sites were directly sutured in 14 patients (8 of which required a split skin paddle technique). Four patients required an adjacent perforator flap, and 3 patients received an ipsilateral groin flap. The size of the adjacent perforator flaps ranged from 15 × 5 to 17 × 6 cm. The groin flaps ranged from 18 × 6 to 28 × 6 cm. All the flaps had excellent appearance and texture. A linear scar in the donor area was not conspicuous and achieved an aesthetic appearance.Lessons:The ALT flap donor site based on the oblique branch pedicle can be directly closed without skin grafts through the use of several surgical techniques.

IntroductionPeroneal artery perforator flaps are the most widely used pedicled flaps for soft tissue defects of the distal lower extremity. Most research regarding peroneal artery flaps focuses on the location, diameter, and number of peroneal artery perforators. However, there is little literature regarding interperforator flow patterns within the peroneal artery perforator flaps. The aims of the present study were to describe interperforator flow patterns of the distally based extended peroneal artery perforator flaps through digital subtraction angiography and review their clinical application.MethodsTwelve consecutive patients underwent digital subtraction angiography of the lower-limb arteries. The number and classification of peroneal artery perforators and the interperforator flow patterns were observed. Based on these observations, distally based extended peroneal artery perforator flaps were designed to repair nonhealing wounds located on the ankles and feet of 14 patients.ResultsThe peroneal artery gives out grades I to IV perforators in the lateral leg. There were 2 to 7 grade I perforators and true anastomoses between adjacent grade II perforators, which generate directly linked vessels in the middle leg. The grade III or IV perforators form a reticular vascular network through a large number of chock and potential anastomoses. All flaps survived and had excellent appearance and texture.ConclusionsDistally based extended peroneal artery perforator flaps appear reliable for repairing wounds located on or around the ankle and front foot. However, whether the middle perforator or peroneal artery should be used depends on the condition of the anastomosis between direct linking vessels and the distal perforator.