Biceps femoris perforator free flap for upper extremity reconstruction: anatomical study and clinical series

Perforator flaps are an important development in reconstructive surgery. The description of new perforator flaps is an open field in anatomical and surgical research.

The anatomy of the musculocutaneous perforating vessels of the short head of the biceps femoris muscle was investigated as a possible source for free tissue transfer in 10 fresh specimens. A series of 10 free biceps femoris perforator flaps for upper extremity reconstruction is described.

There were three constant sizable perforators, located at 6 cm (range, 5 to 6.5 cm), 11.6 cm (range, 10 to 14 cm), and 15.3 cm (range, 14 to 17 cm), respectively, from the knee joint line. The distalmost perforator was a branch off the superior lateral genicular artery in all anatomical specimens. The middle perforator was a direct branch off the popliteal artery in 60 percent of the cases and off the profunda femoris in the remaining 40 percent. The uppermost perforator was usually a branch off the middle perforator. The flaps of the clinical series were based on the middle perforator (11.6 cm). All 10 free flaps were used for upper extremity trauma coverage, with a 100 percent success rate, although one flap required pedicle revision because of arterial thrombosis and developed partial necrosis. Donor-site delayed wound healing occurred in two patients.

The vascular anatomy is relatively constant. Flap dissection is straightforward under tourniquet control, donor morbidity is low provided a primary closure is possible, and pedicle size is appropriate for repair. When a moderate-size free flap with moderate thickness and a medium-sized pedicle is needed, the biceps femoris perforator flap should be considered in the first-choice group of donor areas.