Lateral circumflex femoral artery system: Warehouse for functional composite free-tissue reconstruction of the lower leg

Background: Microsurgical free-flap surgery has progressed from simply providing wound coverage to restoring a high level of function. The concepts and practice of using compound, composite, and chimeric flaps have recently further enhanced the versatility of free flaps in reconstructive surgery. A lateral circumflex femoral arterial (LCFA) system can provide a potential single composite free-tissue transfer for restoration of functional and structural integrity. Methods: Between 1997 and 2003, we used 44 free flaps to restore functional and structural defects in the lower limbs. The versatility of the LCFA system allowed utilization of the anterolateral thigh, vastus lateralis, tensor fascia lata, rectus femoris, and iliac crest. Combinations of tissues from this system were employed to restore defects in the patellar tendon (14), Achilles tendon (13), extensor hallucis tendon (2), anterior compartment with/without lateral compartment muscle (11), anterior compartment muscle and segmental tibial bone (3), and composite calcaneus (1). Results: The free-flap success rate was 97.7%. Four re-explorations were performed with one subsequent failure. Eight patients (18.2%) developed wound infections, of which two required secondary amputations, resulting in a limb salvage rate of 95.4%. Conclusion: The LCFA system provides a predictable and versatile surplus of tissue necessary to restore functional and structural integrity of the posttraumatic lower extremity in a single stage.