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.

Fasciocutaneous Free Flaps Are More Reliable Than Muscle Free Flaps in Lower Limb Trauma Reconstruction: Experience in a Single Trauma Center

“…Although this study does not preclude the use of local flap options, and certainly we have had success with such options, 27,28 where a free flap is indicated, the current study highlights that unlike widespread past opinion, FC flaps may in fact lead to improved outcomes.…”

Perforating arteries of the thigh: An anatomical and radiological study

“…The perforating branches of the profunda femoris artery have numerous clinical implications. Examples include providing an important collateral circulation in atherosclerotic disease, being in danger of iatrogenic injury in surgical fixation of femoral fractures and providing a basis for reconstructive surgery and embolisation.…”

Profunda femoris artery perforator flap for lateral knee joint reconstruction: A report of two cases

“…To our knowledge, only two studies have reported knee joint reconstruction using this flap; one study included seven patients with soft tissue defects measuring 100–150 cm 2 around the knee joint 5 , and the other described a single patient who underwent the reconstruction of a soft tissue defect measuring 8 × 6 cm on the lateral aspect of the knee joint. 6 …”