To describe the intramuscular neurovascular anatomy of the rectus femoris muscle and to evaluate whether the muscle can be split into two functional units, 40 rectus femoris muscle specimens were studied. Ten fresh human cadavers were injected with a mixture of lead oxide, gelatin, and water through the femoral arteries. The rectus femoris muscle with its neurovascular pedicles was dissected out and then radiographed. Computer wire was sutured to each nerve branch in the muscle, and the muscle was radiographed again. Radiographs with and without radiopaque wire were then analyzed. In 10 preserved cadavers, the rectus femoris muscle was dissected out. Note was made of the vessel and nerve to the muscle. All muscles were cut serially into 2-cm cross-sections, and the position and course of the intramuscular tendon were then grossly examined. Three different vascular patterns in 40 rectus femoris muscles were found, based on the number of vascular pedicles and their relative dominance within the muscle. The rectus femoris muscle received either a single vascular pedicle (12.5 percent), a dominant vascular pedicle and one or two minor pedicles (80 percent), or two dominant vascular pedicles (7.5 percent). The rectus femoris was innervated by a large nerve branch from the posterior division of the femoral nerve, and the branch generally divided into two sub-branches before it reached the muscle. Both branches were respectively accompanied by arterial branches to form neurovascular hila. Furthermore, this present study has provided a detailed description of the intramuscular neurovascular territories. Also, the pattern of neurovascular supply of the muscle makes it possible to subdivide the muscle into two functional units for segmental muscle transfer.

In this article, the authors review the literature regarding perforator flaps. Musculocutaneous perforator flaps have evolved from musculocutaneous flaps and offer several distinct advantages. By sparing muscle tissue, thus reducing donor site morbidity and functional loss, perforator flaps are indicated for a number of clinical problems. The versatility of the perforator flap makes it ideal for the reconstruction of three-dimensional defects such as breast reconstruction or as a thin flap for resurfacing shallow wounds when bulk is considered a disadvantage. The authors review the historical development of the perforator flap and discuss the advantages and disadvantages of perforator flaps compared with free and pedicled musculocutaneous flaps. The nomenclature traditionally used for perforator flaps is confusing and lacks a standardized anatomic basis. The authors present a method to describe all perforator flaps according to their artery of origin.

Background: The diagnosis of melanoma at an early, curable stage is an important challenge for clinicians. Confocal scanning laser microscopy (CSLM) is a high-resolution, noninvasive technology that may facilitate improved diagnostic accuracy over clinical examination. The aim of this study was to evaluate the diagnostic accuracy of CSLM compared to dermoscopy in a prospective examination of benign and malignant melanocytic lesions. Methods: 125 patients with suspicious pigmented lesions were prospectively recruited to undergo a clinical, dermoscopic and CSLM examination. A diagnosis was made preoperatively with each technique, and the lesion was then excised and diagnosed using histopathology. Results: 125 patients with 125 lesions were studied comprising 88 melanocytic nevi and 37 melanomas. Dermoscopy had a sensitivity of 89.2%, a specificity of 84.1%, a positive predictive value of 70.2% and a negative predictive value of 94.9%. CSLM was found to have a sensitivity of 97.3%, a specificity of 83.0%, a positive predictive value of 70.6% and a negative predictive value of 98.6%. No melanomas were misidentified when both techniques were used together. Conclusions: CSLM had a relatively higher sensitivity than dermoscopy; however, the specificity was similar with CSLM and dermoscopy. These results suggest that dermoscopy and CSLM are complementary.

The standard method for the study of perforator flap is the lead oxide-gelatin technique. However, other methods can provide complementary information on vascular anatomy.

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.