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METHODS base of the flap. A superiorly-based flap was planned from
the anterolateral aspect of the thigh, with the base of the
The study was conducted and approved at the Jubilee Institute flap at the lateral end of the inguinal defect, at the level
for Surgery of Hand, Aesthetics and Microsurgery, Jubilee of the greater trochanter of femur. The anterior border
Mission Hospital, Thrissur, India. The patients were of the flap starts at the lateral border of the soft tissue
enrolled in the Plastic Surgery Department of the Jubilee defect. The flap is elevated from distal to proximal in the
Mission Hospital. A soft tissue reconstruction with a plane superficial to the TFL, preserving the perforators to
superiorly-based perforator plus flap was planned and the flap from the lateral side. The pivot point lies over the
executed after assessment of the inguinal defect. Seven lateral aspect of the base of the flap. The posterior border
patients with inguinal soft tissue defects were operated on is planned according to the size of the defect. The medial
from January 2013 to September 2013. The postoperative flap, overlying the soft tissue of the anterior thigh, was
period following reconstructive surgery, the hospital elevated superficial to the deep fascia of the thigh. A blunt,
course, and follow-up after radiotherapy was noted in careful dissection is performed at the base of the flap to
patients who had undergone inguinal block dissection. identify as many perforators as possible in these regions.
The size of the perforators is assessed intra-operatively.
Anatomy Because most of the perforators travel from medial
The femoral artery gives off the profunda femoris artery to lateral, medial and lateral perforators with minimal
branch, which arises 2–5 cm below the inguinal ligament dissection could be included within the flap, avoiding
and further divides into the medial and lateral circumflex kinking of the vessels. With adequate medial perforators,
femoral arteries. The lateral circumflex femoral artery further some lateral perforators could easily be sacrificed without
divides into the ascending, transverse and descending compromising flap viability. Care is taken to include some
branches. The ascending lateral circumflex femoral artery branches of the lateral cutaneous nerve of the thigh to the
travels in a superolateral direction from medial to lateral. flap. Anterior branches of the lateral cutaneous nerve lying
These branches provide many musculocutaneous and over the fascia should be carefully preserved for this reason.
septocutaneous perforators which supply the skin over The medial and lateral flaps are transposed in such way to
the lateral aspect of the thigh. The vascularity of the skin, provide coverage to the inguinal defect and easy closure of
subcutaneous tissue and TFL flap is based on the excellent the donor defect. Flap inset is then completed. Hyperbaric
longitudinal network of vessels overlying the iliotibial tract oxygen therapy was administered in the postoperative
formed by anastomoses between branches of the transverse period for six sessions.
branch of the lateral circumflex femoral and individual
branches of the profunda perforators, which emerge along RESULTS
the lateral intermuscular septum [Figure 1].
Five patients presented with malignant tumors involving the
Surgical technique inguinal lymph node and 2 patients presented with defects
Surgery was performed under general or regional following trauma. Their ages ranged from 8 to 59 years
anesthesia with the patient in the supine position. The soft with a mean of 41.7 years. Among 7 patients, 5 were
tissue defect following block dissection or debridement was males, and 2 were females. In all cases, a superiorly-based
measured, and the flap was planned. A hand-held Doppler perforator plus flap was performed. The size of the defect
was used to identify the location of the perforators at the ranged from 9 cm × 4 cm to 17 cm × 8 cm. Flap with

Figure 1: Anatomical description of the superiorly-based perforator plus flap
90 Plast Aesthet Res || Vol 1 || Issue 3 || Dec 2014