PMC4623545_01
Arteriogram showing the lower right extremity (healthy extremity) and the lower left extremity (revascularized extremity). The arrow indicates the superficial right femoral artery (left picture) and the left deep femoral artery (right picture).
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F0001
A 48-years-old man had underlying chronic lower extremity ischemia, Fontaine grade IIB, with occlusion of the superficial femoral artery (Figure 1) and extensive collateral circulation through the deep femoral artery. Musculocutaneous perforators were then located (Figure 2); these could only come from the rectus femoris branch of the descending branch of the lateral circumflex femoral artery, as the superficial femoral artery was occluded (Figure 1).
Illustration of AMT perforator flap based on the musculocutaneous rectus femoris branch perforator (x) of the descending branch of the lateral circumflex femoral artery, which is surrounded by a vessel loop. Abbreviation: AMT = Anteromedial thigh.
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F0002
Musculocutaneous perforators were then located (Figure 2); these could only come from the rectus femoris branch of the descending branch of the lateral circumflex femoral artery, as the superficial femoral artery was occluded (Figure 1). The presence of this perforator facilitated the procedure, and a skin paddle was designed to coincide with the perforator, which was transposed to cover the inguinal defect (Figure 2).
Illustration of AMT perforator flap after its insetting into the groin defect. Donor site is closed primarily. Abbreviation: AMT = Anteromedial thigh.
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F0003
Donor site was primarily closed after the insetting of AMT perforator flap into the groin defect (Figure 3).
Illustration of the final result 2 months after surgery: coverage of the bypass with the AMT perforator flap and closure of the wound. Abbreviation: AMT = Anteromedial thigh.
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F0004
Final result was good coverage of the bypass and closure of the wound after 2 months (Figure 4).