The Profunda Femoris Artery “Fourth Perforator” Island Flap: A New Perforator Flap in Lower-Limb Reconstruction

ABSTRACT

Although the lateral thigh flap has been well described as a fasciocutaneous flap based on one or more of the four perforators of the profunda femoris artery, the role for these individual perforators as perforator flaps has not been described. These profunda femoris artery perforators offer a particularly useful option in lower-limb reconstruction. In fact, a perforator flap based on the profunda femoris artery fourth perforator (PFA-P4) has not been described to our knowledge. We describe the utility of the PFA-P4 flap, offering modes of preoperative imaging and a role for its use in lower-limb reconstruction. Computed tomographic angiography (CTA) was able to identify the location and course of a PFA-P4, and Doppler ultrasound confirmed the CTA findings. A FA-P4 flap was designed and harvested, with direct closure of the donor site achieved. There were no operative complications. Perforator flaps based on the perforating branches of the profunda femoris artery have not been widely described, largely due to individual variability in perforator anatomy. With the advent of CTA for perforator mapping, the “freestyle” nature of such flaps is eliminated, and perforator flaps such as the PFA-P4 flap can be planned and harvested safely and confidently.

Perforator flap - fasciocutaneous - preoperative imaging

REFERENCES

• 1 Baek S M. Two new cutaneous free flaps: the medial and lateral thigh flaps.  Plast Reconstr Surg. 1983;  71 354-365
• 2 Bilterys L, Coopman J, Veys A. Bilobed gluteus maximus myocutaneous and lateral thigh fasciocutaneous flap.  Acta Chir Belg. 1986;  86 253-254
• 3 Maruyama Y, Ohnishi K, Takeuchi S. The lateral thigh fascio-cutaneous flap in the repair of ischial and trochanteric defects.  Br J Plast Surg. 1984;  37 103-107
• 4 Song Y G, Chen G Z, Song Y L. The free thigh flap: a new free flap concept based on the septocutaneous artery.  Br J Plast Surg. 1984;  37 149-159
• 5 Ahmadzadeh R, Bergeron L, Tang M, Geddes C R, Morris S F. The posterior thigh perforator flap or profunda femoris artery perforator flap.  Plast Reconstr Surg. 2007;  119 194-200 discussion 201-202
• 6 Papon X, Pasco A, Fournier H D, Baron A, Cronier P, Mercier P. Descriptive anatomic study of the fourth perforating artery of the femoral system.  Surg Radiol Anat. 1999;  21 277-281
• 7 Salvador-Sanz J F, Torres A N, Calpena F T, Sanz-Gimenez-Rico J R, Lopez S C, Barraquer E L. Anatomical study of the cutaneous perforator arteries and vascularisation of the biceps femoris muscle.  Br J Plast Surg. 2005;  58 1079-1085