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Reappraisal of Perforasomes of the Superficial Femoral, Descending Genicular, and Saphenous Arteries and Clinical Applications to Locoregional Reconstruction

Mohan, Anita T., M.R.C.S., B.Sc.; Zhu, Lin, M.D.; Morsy, Mohamed, M.B.B.Ch.; Sur, Yoo Joon, M.D., Ph.D.; Michalak, Gregory J., Ph.D.; Lachman, Nirusha, Ph.D.; Mardini, Samir, M.D.; Saint-Cyr, Michel, F.R.C.S.(C.)

Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3 - p 613e-627e
doi: 10.1097/PRS.0000000000005395
Reconstructive: Lower Extremity: Original Articles
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Background: The superficial femoral artery and medial thigh region has been an underused donor site for perforator flaps. This study evaluated perforasomes of the superficial femoral artery and its principal branches to review the clinical applications for locoregional reconstruction.

Methods: Twenty-six fresh cadaveric lower extremities were dissected. Perforator size and anatomical course from the superficial femoral artery, descending genicular artery, and saphenous artery branch were documented. Perforators were selectively injected with iodinated contrast to assess vascular territories using computed tomography. A retrospective chart review was conducted on consecutive patients (2014 to 2015).

Results: One hundred thirty perforators were mapped in the medial thigh region. Eleven extended medial thigh perforator flaps and 15 hemicircumferential flaps were harvested. The mean distance from the joint line was 16.7 ± 7.3 cm. Perforators arose from the superficial femoral artery (62 percent), saphenous artery branch (23 percent), and descending genicular artery (15 percent). Superficial femoral artery perforators were located around the mid and proximal thigh region (p < 0.001). The median perforasome surface area was 244 cm2, representing 36 percent in hemithigh flaps with preferential filling in the anteromedial region. Proximal perforasomes were the smallest. Perforasome areas based on vessel origin were comparable; however, saphenous artery perforators had a broader perforasome compared with descending genicular (p = 0.01) and superficial femoral artery perforators (p = 0.04). Six clinical case examples were presented for knee, thigh, and lower leg reconstruction.

Conclusions: The superficial femoral artery or its branches can provide nontraditional reconstructive perforator flap options in regional reconstruction. They can be simple to harvest using a free-style approach, do not require preoperative imaging, offer a one-stage reconstructive method with low morbidity, and obviate the need for microsurgery or muscle flaps.

Rochester, Minn.; London and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt

From the Division of Plastic Surgery, the Division of Radiology, Biomedical Resource Imaging, and the Department of Anatomy, Mayo Clinic; the Restoration of Appearance and Function Trust; the Department of Surgery, University of Cambridge; the Department of Orthopedic Surgery, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea; and the Department of Orthopedic Surgery, Assiut University Hospital, Assiut University.

Received for publication August 6, 2016; accepted July 31, 2018.

Presented at the Eighth Biennial Congress of the World Society for Reconstructive Microsurgery, in Mumbai, India, March 19 through 22, 2015.

Disclosure:The authors have no financial disclosure or conflicts of interest to declare.

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Michel Saint-Cyr, F.R.C.S.(C.), Division of Plastic Surgery, Baylor, Scott and White, 2401 South 31st Street, Temple, Texas 76508, michel.saintcyr@bswhealth.org, Twitter: @anitatmohan, Instagram: @anitatmohan, @mayoclinicplasticsurgery

Copyright © 2019 by the American Society of Plastic Surgeons