RSS-Feed abonnieren
DOI: 10.1055/s-0037-1604087
Variations in the Anterolateral Thigh Flap's Vascular Anatomy in African Americans
Publikationsverlauf
08. Februar 2017
24. Mai 2017
Publikationsdatum:
07. Oktober 2017 (online)
Abstract
Background Variations in anterolateral thigh (ALT) arterial anatomy are well documented. Ethnicity is a known risk factor for vascular variation in several organ systems, but its impact on ALT anatomy has not been studied. Anecdotally, we observed frequent ALT arterial variation in African American (AA) patients. We thus hypothesized that AA patients have higher rates of anomalous branching.
Materials and Methods A total of 277 computed tomography angiograms (513 lower extremities) captured between May 1, 2013 and May 31, 2015 at a tertiary academic medical center were retrospectively analyzed to determine ALT arterial branching. Patient records were examined to ascertain demographics. Data were analyzed using descriptive statistics and multinomial logistic regression.
Results Males comprised 84.5%. Ethnic distribution was 55.2% AA and 36.5% Caucasian. The descending branch of the lateral circumflex femoral artery (dLCFA) originated from non-LCFA arteries (deep femoral, common femoral, or superficial femoral arteries) in 18.9% of Caucasian versus 9.1% of AA (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.33–3.93, p < 0.01). An oblique branch was identified in 41.1% of Caucasian versus 51.9% of AA (OR: 1.56; 95% CI: 1.08–2.24, p = 0.02). Ethnicity was the only driving factor of dLCFA and oblique branch of the LCFA (oLCFA) anatomy (Wald chi-square: 14 and 11, p = 0.03 and 0.02, respectively).
Conclusions Ethnicity significantly affects ALT arterial anatomy. AA are more likely to have classical dLCFA branching with a fourth oLCFA branch. A flap with an unrecognized oLCFA-dominant supply places patients at a higher risk for flap failure and loss. We recommend preoperative imaging before undertaking an ALT flap reconstruction.
-
References
- 1 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37 (02) 149-159
- 2 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109 (07) 2219-2226 , discussion 2227–2230
- 3 Wong C-H, Wei F-C, Fu B, Chen Y-A, Lin J-Y. Alternative vascular pedicle of the anterolateral thigh flap: the oblique branch of the lateral circumflex femoral artery. Plast Reconstr Surg 2009; 123 (02) 571-577
- 4 Lin C-H, Wei FC, Lin YT, Yeh JT, Rodriguez EdeJ, Chen CT. Lateral circumflex femoral artery system: warehouse for functional composite free-tissue reconstruction of the lower leg. J Trauma 2006; 60 (05) 1032-1036
- 5 Kuo YR, Jeng SF, Kuo MH. , et al. Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site. Plast Reconstr Surg 2001; 107 (07) 1766-1771
- 6 Kimata Y, Uchiyama K, Ebihara S. , et al. Anterolateral thigh flap donor-site complications and morbidity. Plast Reconstr Surg 2000; 106 (03) 584-589
- 7 Lutz BS. Aesthetic and functional advantages of the anterolateral thigh flap in reconstruction of tumor-related scalp defects. Microsurgery 2002; 22 (06) 258-264
- 8 Lakhiani C, DeFazio MV, Han K, Falola R, Evans K. Donor-site morbidity following free tissue harvest from the thigh: a systematic review and pooled analysis of complications. J Reconstr Microsurg 2016; 32 (05) 342-357
- 9 Yu P. Reinnervated anterolateral thigh flap for tongue reconstruction. Head Neck 2004; 26 (12) 1038-1044
- 10 Hong JP, Choi J-W, Chang H, Lee TJ. Reconstruction of the face after resection of arteriovenous malformations using anterolateral thigh perforator flap. J Craniofac Surg 2005; 16 (05) 851-855
- 11 Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg 2006; 59 (02) 153-157
- 12 Huang W-C, Chen HC, Jain V. , et al. Reconstruction of through-and-through cheek defects involving the oral commissure, using chimeric flaps from the thigh lateral femoral circumflex system. Plast Reconstr Surg 2002; 109 (02) 433-441 , discussion 442–443
- 13 Lin Y-T, Lin C-H, Wei F-C. More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2006; 59 (06) 622-627
- 14 Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 1998; 102 (05) 1517-1523
- 15 Choi S-W, Park JY, Hur MS. , et al. An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap. J Craniofac Surg 2007; 18 (04) 866-871
- 16 Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg 2012; 130 (06) 1254-1268
- 17 Lee Y-C, Chen W-C, Chou T-M, Shieh S-J. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications. Plast Reconstr Surg 2015; 135 (04) 1097-1107
- 18 Uzel M, Tanyeli E, Yildirim M. An anatomical study of the origins of the lateral circumflex femoral artery in the Turkish population. Folia Morphol (Warsz) 2008; 67 (04) 226-230
- 19 Bhujel N, Johnston C, Parmar S, Martin T. An unusual anatomical variant of the vascular anatomy in the anterolateral thigh free flap. Int J Oral Maxillofac Surg 2010; 39 (01) 94-95
- 20 Chen H-H, Lin MS, Chou EK. , et al. Anterolateral thigh perforator flap: varying perforator anatomy. Ann Plast Surg 2009; 63 (02) 153-155
- 21 Fukuda H, Ashida M, Ishii R, Abe S, Ibukuro K. Anatomical variants of the lateral femoral circumflex artery: an angiographic study. Surg Radiol Anat 2005; 27 (03) 260-264
- 22 Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg 1989; 42 (03) 260-262
- 23 Seth R, Manz RM, Dahan IJ. , et al. Comprehensive analysis of the anterolateral thigh flap vascular anatomy. Arch Facial Plast Surg 2011; 13 (05) 347-354
- 24 Rozen WM, Ashton MW, Pan WR. , et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery 2009; 29 (01) 16-23
- 25 Pribaz JJ, Orgill DP, Epstein MD, Sampson CE, Hergrueter CA. Anterolateral thigh free flap. Ann Plast Surg 1995; 34 (06) 585-592
- 26 Yu P, Sanger JR, Matloub HS, Gosain A, Larson D. Anterolateral thigh fasciocutaneous island flaps in perineoscrotal reconstruction. Plast Reconstr Surg 2002; 109 (02) 610-616 , discussion 617–618
- 27 Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 1993; 92 (03) 421-428 , discussion 429–430
- 28 Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surg Radiol Anat 2001; 23 (01) 33-38
- 29 Wei F-C, Mardini S. Free-style free flaps. Plast Reconstr Surg 2004; 114 (04) 910-916
- 30 Ross GL, Dunn R, Kirkpatrick J. , et al. To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects. Br J Plast Surg 2003; 56 (04) 409-413
- 31 Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck 2004; 26 (09) 759-769
- 32 Wong C-H, Kao H-K, Fu B, Lin J-Y. A cautionary point in the harvest of the anterolateral thigh myocutaneous flap. Ann Plast Surg 2009; 62 (06) 637-639
- 33 Wong C-H. The oblique branch trap in the harvest of the anterolateral thigh myocutaneous flap. Microsurgery 2012; 32 (08) 631-634
- 34 Kawai K, Imanishi N, Nakajima H, Aiso S, Kakibuchi M, Hosokawa K. Vascular anatomy of the anterolateral thigh flap. Plast Reconstr Surg 2004; 114 (05) 1108-1117
- 35 Chana JS, Wei F-C. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg 2004; 57 (07) 603-609
- 36 Valdatta L, Tuinder S, Buoro M, Thione A, Faga A, Putz R. Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg 2002; 49 (02) 145-150
- 37 Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg 2006; 118 (04) 928-933 , discussion 934–935
- 38 Tsukino A, Kurachi K, Inamiya T, Tanigaki T. Preoperative color Doppler assessment in planning of anterolateral thigh flaps. Plast Reconstr Surg 2004; 113 (01) 241-246
- 39 Garvey PB, Selber JC, Madewell JE, Bidaut L, Feng L, Yu P. A prospective study of preoperative computed tomographic angiography for head and neck reconstruction with anterolateral thigh flaps. Plast Reconstr Surg 2011; 127 (04) 1505-1514
- 40 Cipriani R, Contedini F, Caliceti U, Cavina C. Three-dimensional reconstruction of the oral cavity using the free anterolateral thigh flap. Plast Reconstr Surg 2002; 109 (01) 53-57
- 41 Kim EK, Kang BS, Hong JP. The distribution of the perforators in the anterolateral thigh and the utility of multidetector row computed tomography angiography in preoperative planning. Ann Plast Surg 2010; 65 (02) 155-160
- 42 Shieh SJ, Chiu HY, Yu JC, Pan SC, Tsai ST, Shen CL. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg 2000; 105 (07) 2349-2357 , discussion 2358–2360
- 43 Chen SY, Lin WC, Deng SC. , et al. Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction. Eur J Surg Oncol 2010; 36 (10) 1004-1011
- 44 Lichte J, Teichmann J, Loberg C. , et al. Routine preoperative colour Doppler duplex ultrasound scanning in anterolateral thigh flaps. Br J Oral Maxillofac Surg 2016; 54 (08) 909-913
- 45 Dorfman D, Pu LLQ. The value of color duplex imaging for planning and performing a free anterolateral thigh perforator flap. Ann Plast Surg 2014; 72 (Suppl. 01) S6-S8
- 46 Ensat F, Babl M, Conz C. , et al. The efficacy of color duplex sonography in preoperative assessment of anterolateral thigh flap. Microsurgery 2012; 32 (08) 605-610
- 47 Liu S-C, Chiu WK, Chen SY, Lee TP, Wang HW, Chen SG. Comparison of surgical result of anterolateral thigh flap in reconstruction of through-and-through cheek defect with/without CT angiography guidance. J Craniomaxillofac Surg 2011; 39 (08) 633-638
- 48 Zhang Y, Pan X, Yang H, Yang Y, Huang H, Rui Y. Computed Tomography Angiography for the Chimeric Anterolateral Thigh Flap in the Reconstruction of the Upper Extremity. J Reconstr Microsurg 2017; 33 (03) 211-217