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Junctional and Extremity Vascular Trauma
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
David S. Kauvar, Mohammed Mar’ae Asieri
Ligation as a vascular damage control manoeuvre is rarely the first choice for major junctional or extremity arterial injuries. Some arterial injuries may be safely ligated as a definitive vascular procedure. In the upper extremity, generous collateral circulation can permit ligation of the distal axillary and brachial arteries with preservation of Doppler signals in the palmar arch. Most upper extremities are ulnar-dominant, meaning that the radial artery can be ligated without producing hand and digital ischaemia. Confirmation of a Doppler signal in the distal radial artery with the proximal vessel occluded (Allen test) is mandatory if the vessel is to be definitively ligated. In the lower extremity, secondary and more distal branches of the profunda femoris artery (PFA) and single tibial arteries may generally be safely ligated. Definitive ligation of other named lower extremity arteries is likely to produce clinically significant distal ischaemia.
Test Paper 7
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
The ‘down the leg’, antegrade, approach via a right common femoral artery puncture is the easiest and most direct approach. Retrograde puncture is usually used for angiography and intervention at the iliac systems, aorta and aortic branches. Ultrasound scan is commonly used to visualise the vessels during puncture. The puncture can also be safely performed using anatomical landmarks and feeling for the femoral pulse. The CFA can be found in the mid-point between the anterior superior iliac spine and the symphysis pubis. By using USS, the local anaesthetic can be accurately placed around the vessel, ensuring good analgesia. The profunda femoris artery can also be visualised and hence minimise the chance of accidental puncture. The popliteal artery can be punctured using ultrasound guidance at the popliteal fossa, but it would not be preferred in this case.
Femoral shaft, distal femoral and periprosthetic fractures
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
The anterior compartment contains the quadriceps, sartorius, pectineus and terminal iliopsoas muscles. The anterior muscles are supplied by the femoral nerve. The blood supply is largely derived from the profunda femoris artery. The medial (adductor) compartment contains the adductors longus, brevis and magnus, supplied by the obturator nerve and obturator branch of the internal iliac artery.
Imaging changes following surgery for ischiofemoral impingement
Published in Baylor University Medical Center Proceedings, 2023
Munif Hatem, Richard Feng, Jordan Teel, Hal David Martin
All surgical procedures were performed by the same surgeon. Patients were positioned supine on a traction table with 20° of contralateral tilt. Patients with positive intraarticular injection test preoperatively underwent intraarticular assessment and associated procedures. The LT plasty was performed endoscopically through a posterolateral approach.3 Three portals were utilized: anterolateral, auxiliary proximal, and auxiliary distal (Figure 2). The LT was reached through a window in the quadratus femoris muscle between the medial femoral circumflex artery and first perforating branch of the profunda femoris artery (Figure 3). The amount of LT to be resected was determined according to the preoperative ischiofemoral space measured on the MRI with controlled positioning of the lower limbs. The observation of hard impingement bone was also utilized as an intraoperative guide for the LT plasty.
Use of the profunda artery perforator flap in vulvo-perineal reconstruction
Published in Journal of Obstetrics and Gynaecology, 2018
S.S. Jing, B. Winter-Roach, D. Kosutic
The PAP flap has a reliable blood supply. In a fresh cadaveric study by Ahmadzadeh et al. (Ahmadzadeh et al. 2007), the average number of perforators from the profunda femoris artery was 5 +/2 (65% septocutaneous and 35% musculocutaneous). They derive from either the medial or lateral branches of the main artery. The medial branches supply the adductor compartment while the lateral branches supply the posterior compartment of the thigh. The medial perforators have the largest vascular cutaneous territory. The most proximal perforators are located at the inferior gluteal fold, and the most distal lies approximately 10 cm proximal to the femoral condyle. The average internal diameter of the perforators was 0.8+/0.3 mm. The pedicle length from the profunda femoris artery was 68+/33 mm. However, it can be as long as 13 cm. This allows it to be used in free tissue transfer (Allen et al. 2012). The internal pudendal nerve can be taken with the flap for the neo-vulva (Chen et al. 2015).
The evolution of breast reconstructions with free flaps: a historical overview
Published in Acta Chirurgica Belgica, 2023
Filip E. F. Thiessen, Nicolas Vermeersch, Thierry Tondu, Veronique Verhoeven, Lawek Bersenji, Yves Sinove, Guy Hubens, Gunther Steenackers, Wiebren A. A. Tjalma
The use of the posterior thigh as donor site for autologous breast reconstruction was introduced in 2012 by Allen et al. They were the first to use the profunda artery perforator (PAP) flap for breast reconstruction. This flap is the perforator version of the posterior thigh myocutaneous flap used to reconstruct pressure sores. It is based on a perforator of the deep femoral vessels (profunda femoris artery and vein) coursing through the adductor magnus muscle. Advantages compared to the TUG/TMG flap are a longer pedicle, sparing the muscles and orienting the skin island away from the lymph nodes in the femoral triangle. Disadvantages are related to the transverse orientation of the flap [70].