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Review Question - QID 212941

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QID 212941 (Type "212941" in App Search)
A 32-year-old man sustains a traumatic amputation of his right thumb (Figure A). He undergoes the soft-tissue coverage procedure shown in Figure B. What artery does this flap rely on, and which nerve is at risk during this procedure?
  • A
  • B

Medial femoral circumflex artery; femoral branches of genitofemoral nerve

2%

49/2302

Medial femoral circumflex artery; lateral femoral cutaneous nerve

6%

135/2302

Superficial circumflex iliac artery; femoral branches of genitofemoral nerve

12%

279/2302

Superficial circumflex iliac artery; lateral femoral cutaneous nerve

64%

1468/2302

Superficial circumflex iliac artery; ilioinguinal nerve

15%

348/2302

  • A
  • B

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Soft-tissue coverage of this patient's injury was achieved using a groin flap, which relies on the superficial circumflex iliac artery. The lateral femoral cutaneous nerve is at risk during this procedure.

Groin flaps are axial flaps that are useful for providing soft-tissue coverage to the upper extremity. They are based on the superficial circumflex iliac artery. Caution must be taken when raising these flaps in order to avoid injury to the lateral femoral cutaneous nerve. The lateral femoral cutaneous nerve pierces the iliac fascia below the inguinal ligament, medial to the anterior superior iliac spine, and lies directly in the field of dissection when a groin flap is raised.

Chuang et al. published a review on groin flap design and versatility. They report that the groin flap is a reliable and well-established reconstructive option for pedicled or free-tissue transfer. They discuss the "rule of two finger widths", a simplified guideline used to overcome concern regarding the flap's variable vascular origin, which is based on the transverse diameter of the patient's index and long fingers at the distal interphalangeal level.

Yannascoli et al. published a review on the management of soft tissue defects of the hand. They report that groin flaps provide a large amount of soft tissue, offer the advantage of a conspicuous donor site, and are one of the thinnest options available.

Figure A is a clinical image of a traumatic left thumb amputation. Figure B is a clinical image of a groin flap. Illustration A is a diagram depicting the anatomy of a groin flap.

Incorrect Answers:
Answers 1, 2, 3, and 5: Groin flaps are based on the superficial circumflex iliac artery and place the lateral femoral cutaneous nerve at risk.

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