The posterior thigh perforator flap or profunda femoris artery perforator flap

The thigh donor site has been used extensively for microsurgical tissue transfer; however, the posterior thigh has been neglected as a potential donor site. The perforators of the profunda femoris artery supply large cutaneous territories that could be useful for lower extremity coverage. The purpose of this article is to evaluate the anatomical basis of the posterior thigh perforator flap and to provide anatomical landmarks with which to facilitate flap dissection.

Six fresh cadavers underwent a whole-body, intraarterial injection of a lead oxide and gelatin preparation. The integument of the posterior thigh was dissected (n = 11), and perforators of the profunda femoris artery were identified. Their type (septocutaneous versus musculocutaneous), course, size, and location were documented by angiography and photography. Surface areas were measured with Scion Image Beta 4.02. Results are reported as mean +/- SD.

The average number of profunda femoris cutaneous perforators in the posterior thigh was 5 +/- 2 (65 percent septocutaneous and 35 percent musculocutaneous), the average internal diameter was 0.8 +/- 0.3 mm, and the pedicle length was 29 +/- 14 mm from the deep fascia and 68 +/- 33 mm from the profunda femoris artery. The average profunda femoris cutaneous vascular territory was 229 +/- 72 cm, with a 46 +/- 13-cm perforator zone. Cutaneous perforators can be found on a line extending from the ischium to the lateral femoral condyle.

The profunda femoris provides cutaneous perforators of large caliber supporting a substantial cutaneous territory. This flap will likely be clinically useful in lower extremity reconstruction as a free or pedicled flap.