The types and management strategies of"venous trap"in the anterior lateral thigh flap surgery
Objective To explore the types and morphological characteristics of"venous trap"during the harvesting of the anterior lateral femoral skin flap,calculate the incidence of"venous traps",and propose corresponding treatment strategies.Methods From January 2021 to July 2022,381 patients with skin and soft tissue defects were repaired with anterior lateral femoral skin flaps.A total of 22 patients with venous traps,including 15 males and 7 females,aged between 26 and 68 years old,were included.The color ultrasound was used for locating perforations in the lateral thigh area before surgery.The superficial vein running in the space between the rectus femoris muscle and the lateral thigh muscle during surgery may affect the surgeon's ability to identify the source artery of the musculocutaneous perforator or cause interference,resulting in misjudgment and misresection of the perforator source artery,which was recorded as a"venous trap".The"venous traps"were classified based on the relationship between veins and myocutaneous perforations,and corresponding treatment strategies were adopt for each type of"venous trap".Results The"venous traps"were divided into five types:type Ⅰ:the veins and myocutaneous perforating branches ran closely but not related,with a total of 10 cases and an incidence rate of 2.6％;type Ⅱ:venous involvement in myocutaneous perforations with accompanying veins,a total of 5 cases,with an incidence rate of 1.3％;type Ⅲ:veins were the continuation of the accompanying veins of the musculocutaneous perforators,with a total of 3 cases and an incidence rate of 0.7％;type Ⅳ:venous distancing from the musculocutaneous perforator,a total of 3 cases,with an incidence rate of 0.7％;type Ⅴ:the vein was not related to the musculocutaneous perforator,but covered up the perforator and source artery,with a total occurrence rate of 0.3％in one case.All 22 flaps survived smoothly after surgery,and no vascular crisis occurred.The donor area all achieved primary healing smoothly.The postoperative follow-up period was 4 to 8 months.At the last follow-up,the skin flap had good color and texture,and sensation partially restored.The donor areas were all linear scars,without any discomfort such as scar contracture or pain,and there were no other serious complications.Conclusion Identifying the types and morphological characteristics of"venous traps"during the harvesting of the anterior lateral femoral skin flap can better clarify the positional relationship between the superficial veins and perforating branches in the anterior lateral femoral area,and minimize misjudgment and miscutting of perforating branches and source arteries due to venous routing and other reasons,thereby improving the success rate of flap harvesting.
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