Use of the Upper Medial Thigh Perforator Flap (Gracilis Perforator Flap) for Lower Extremity Reconstruction

Abstract

The upper medial thigh perforator flap is a free-style skin flap elevated suprafascially from the upper medial thigh in a transverse manner based on any reliable perforator. A total of 40 cases were performed in 40 patients with lower extremity soft-tissue defects from various causes. The anatomy of the flap, the elevation technique, and the results after reconstruction were evaluated. All flaps were raised suprafascially in a free-style flap approach. The average size of the flaps was 71.6 cm2 (vertical width, 6.4 cm; transverse length, 10.9 cm). An average number of 1.3 reliable pulsating pedicles was noted entering the flap, and 90 percent originated from the medial circumflex femoral artery. The perforators were one-third musculocutaneous and two-thirds septocutaneous type. The average length of the pedicle was 6 cm, and the average diameter of the artery was 0.8 mm. The flaps were thinned according to the needs of the patient. The donor sites were closed primarily. Thirty-nine flaps survived, and no recurrence of the original abnormality was seen during the follow-up period. Despite the short pedicle length, small diameter of the vessel, and inconsistent perforator position, the surgeon can use the upper medial thigh perforator flap to overcome the disadvantages by understanding the free-style free flap approach. The flap can obtain reasonable size, well-hidden scar, preservation of muscle function, good pliability, and superficial nerves and vein included for additional quality. This flap, in the hands of experienced surgeons, can be reliable for reconstructing the lower extremity.