Lateral circumflex femoral artery perforator flap for the reconstruction of head soft tissue defects: Cross-region venous anastomosis

Abstract

Background

Owing to its unique characteristics, the lateral circumflex femoral artery perforator (LCFAP) flap is often preferred for repairing head wounds with exposed skulls. However, given the vascular distribution in the head, particularly the veins, can lead to postoperative complications such as venous congestion of the flap. The rates of vascular exploration and necrosis in these flaps are significantly higher than in other body regions. Therefore, it is crucial to identify a safe and effective method for venous anastomosis of free flaps in the head region.

Methods

This retrospective case series study included 10 patients with large head soft tissue defects treated at the Burn and Plastic Surgery Department of the Affiliated Hospital of Zunyi Medical University from January 2020 to December 2022. The head defects were reconstructed using LCFAP flaps, with flap veins anastomosed to the external jugular vein in the neck, either directly or via a bridging technique.

Results

Among the 10 adult patients with massive head wound defects, 7 (70%) were men. The patients’ mean age was 53.0 years (48–59 years). The wound defects were caused by trauma in 6 (60%) patients and by tumors in 4 (40%) patients. Postoperatively, no significant complications occurred, and all LCFAP flap survived without necrosis.

Conclusion

The descending branch of the LCFAP flap effectively repairs massive head wound defects. The venous anastomosis method for this flap is associated with a low incidence of venous complications and a high patency rate, making it a clinically valuable reference.