Perforators of the Anteromedial Thigh Skin and Possible Design of the Anteromedial Thigh Flap: A Cadaveric Study.

Abstract

Specific perforator-based flaps are a new era in plastic reconstruction. They have replaced many of the traditional paradigms in plastic surgery. The anteromedial thigh flap is a versatile flap that can be used as a primary choice for many reconstructive purposes or as a secondary choice for the anterolateral thigh flap. Mapping the vascular territory of anteromedial thigh is essential for the proper design of the flap. The aim of this work was to study the cutaneous perforators of the anteromedial thigh and explain their significance in flap design. The material of this study included 30 fresh cadaveric lower limbs. The external iliac artery was injected with colored latex. Superficial and deep dissections were undertaken under a magnifying lens to locate the perforators and identify their type. The length and diameter of the perforators were measured. Anteromedial thigh skin was divided into 6 squares. Squares 1 and 4 are the upper squares and comprise the skin over the upper medial thigh. It is primarily based on the superficial external pudendal artery, deep external pudendal artery, and superficial circumflex femoral artery. Squares 2 and 5 are the middle squares and were mainly supplied by perforators of the superficial femoral artery. Squares 3 and 6 are the lower squares and were mainly supplied by the saphenous artery and superficial femoral artery. The possible flap designs are then discussed. The anteromedial thigh skin is richly supplied by a mixture of perforators from multiple sources. The segmental nature of the perforators arising from the superficial external pudendal artery, deep external pudendal artery, superficial femoral artery, and saphenous artery together with the long course and large diameter of perforators grant the anteromedial thigh flap its versatility.