The Adductor Flap: A New Method for Transferring Posterior and Medial Thigh Skin

Abstract

Skin flaps from the medial aspect of the thigh have traditionally been based on the gracilis musculocutaneous unit. This article presents anatomic studies and clinical experience with a new flap from the medial and posterior aspects of the thigh based on the proximal musculocutaneous perforator of the adductor magnus muscle and its venae comitantes. This cutaneous artery represents the termination of the first medial branch of the profunda femoris artery and is consistently large enough in caliber to support much larger skin flaps than the gracilis musculocutaneous flap. In all 20 cadaver dissections, the proximal cutaneous perforator of the adductor magnus muscle was present and measured between 0.8 and 1.1 mm in diameter, making it one of the largest skin perforators in the entire body. Based on this anatomic observation, skin flaps as large as 30 x 23 cm from the medial and posterior aspects of the thigh were successfully transferred. Adductor flaps were used in 25 patients. On one patient the flap was lost, in one the flap demonstrated partial survival, and in 23 patients the flaps survived completely. The flap was designed as a pedicle island flap in 14 patients and as a free flap in 11. When isolating the vascular pedicle for free tissue transfer, the cutaneous artery is dissected from the surrounding adductor magnus muscle and no muscle is included in the flap. Using this maneuver, a pedicle length of approximately 8 cm is isolated. In addition to ample length, the artery has a diameter of approximately 2 mm at its origin from the profunda femoris artery. The adductor flap provides an alternative method for flap design in the posteromedial thigh. Because of the large pedicle and the vast cutaneous territory that it reliably supplies, the authors believe that the adductor flap is the most versatile and dependable method for transferring flaps from the posteromedial thigh region.

The Propeller Flap Version of the Adductor Muscle Perforator Flap for Coverage of Ischial or Trochanteric Pressure Sores

“…17,18 A large flap encompassing almost the entire posterior thigh can survive on this single perforator. 15 In the obese individual, identification of the exact location of this perforator can be difficult, but is simplified by a subfascial approach. If designed as a propeller flap with the perforator as the hub, the adductor muscle perforator flap can be rotated to close either an ischial or trochanteric defect and allow simultaneous direct closure of the donor site.…”

“…These used specifically for pressure sores have previously included flaps based on musculocutaneous perforators from the superior 12 and inferior gluteal artery, 13 as well as the first perforator of the profunda femoris artery. 14 Angrigiani et al 15 have also identified a constant, large perforator of the medial posterior thigh arising through the adductor magnus muscle. This can support almost the entire posterior thigh skin territory and was used by them to raise a large thigh flap that could be advanced cephalad for ischial defects, but a skin graft was invariably necessary to close the distal thigh donor site.…”

Breast Reconstruction with the Profunda Artery Perforator Flap

“…Hurwitz described the use of a posterior thigh myocutaneous flap based on the inferior gluteal artery, 4 Angrigiani et al described the transfer of posterior and medial thigh skin based on profunda femoris perforators, 5 and Song et al discussed the use of the posterior thigh perforator free flap. 6 Cadaver studies have shown that the dominant blood supply to the posterior thigh is from the profunda femoris artery perforators.…”

Colgajo póstero-medial de muslo (adductor): a propósito de un caso

“…El pedículo es siempre posterior al borde posterior del músculo recto interno, del semimembranoso y del semitendinoso (Fig.1). Una vez localizado el eje vascular se termina la disección levantando el borde anterior del colgajo, lo que permite su rotación (3,4) (Fig. 2).…”