Anteromedial Thigh Perforator Flap Research Articles

Technique and clinical application of free lobed anteromedial thigh perforator flap

To introduce the technique and clinical application of free lobed anteromedial thigh perforator flap. Between October 2017 and December 2021, 65 patients with buccal and oral cancer penetrating defects were planned to treat with free lobed anterolateral thigh flap transplantation, of which 15 cases were found that the sole anterolateral thigh perforator was actually a branch of the anteromedial thigh perforator, and then the free lobed anteromedial thigh perforator flap was harvested for repair. There were 12 males and 3 females with an average age of 34.6 years (range, 29-55 years). According to Union for International Cancer Control (UICC) TNM staging, there were 7 cases of T 4N 0M 0, 4 cases of T 4N 1M 0, 2 cases of T 3N 1M 0, and 2 cases of T 3N 2M 0. The disease duration was 1-10 months (mean, 6.3 months), and the area of secondary soft tissue defect left after radical resection of buccal and oral cancer was from 5 cm×4 cm to 10 cm×6 cm. The anterolateral thigh skin flap ranged from 5 cm×4 cm to 13 cm×6 cm, and the anteromedial thigh skin flap ranged from 5 cm×3 cm to 10 cm×6 cm. The free trilobed anteromedial thigh flap was prepared according to the actual branches of the main trunk of the anteromedial thigh perforator in 4 cases, and the vastus medialis muscle flap was used to fill the cavity defect of the floor of mouth in 7 cases. Among the 15 patients, the vessel pedicles of the anteromedial thigh perforators were derived from the main femoral artery and vein in 8 cases, from the main descending branch of the lateral femoral circumflex artery in 4 cases, and from the main lateral femoral circumflex artery in 3 cases. Hematoma occurred in 2 cases after operation, which was successfully saved after emergency exploration. No vascular crisis occurred, and partial necrosis of anterolateral femoral skin island occurred in 1 case, which was healed with debridement. The remaining flaps survived successfully, and the wounds and donor site incisions healed by first intention. All the patients were followed up 12-36 months (mean, 14.6 months). The appearance of the flap was satisfactory, and no obvious swelling was found; the mouth opening and language function were satisfactory; only linear scar was left in the donor area, and the thigh function was not significantly affected. Local recurrence occurred in 3 cases, and the defect after tumor resection was repaired with pedicled pectoralis major myocutaneous flap. Four patients with neck lymph node metastasis, including ipsilateral side in 3 patients and contralateral side in the other 1 patient, all underwent neck lymph node dissection again. The 3-year survival rate was 86.7% (13/15). The anteromedial thigh perforator vessels distributed in the anterolateral region of the thigh can be used to prepare the anterolateral thigh split lobed flap to repair the buccal and oral cancer penetrating defects.

Exploration on the method of aesthetic repair of the donor sites of flaps

Objective: To explore the excellent methods for aesthetic repair of the donor sites of flaps. Methods: From January 2013 to March 2018, 120 patients (94 males and 26 females, aged from 3 to 60 years) were admitted to the Department of Burns of Beijing Jishuitan Hospital. Wounds areas after debridement or removing scar were ranged from 8.0 cm×3.5 cm to 24.0 cm×18.0 cm. Twenty patients with facial and neck scar were repaired with expanded flaps, including 4 scalp flaps, 8 supraclavicular flaps, 4 deltoid flaps, and 4 trapezius myocutaneous flaps. The flaps in ideal donor sites were selected to repair the wounds in 40 patients, including 20 cases of hand wounds or scars repaired with inguinal flaps, 10 children of foot skin defects or scars repaired with cross inguinal skin flap, 10 cases of knee joint wounds repaired with medial or lateral thigh flaps. The optimal flap design was used to repair wounds in 50 patients. Among the patients, wounds of 36 patients were repaired with relaying flaps, including donor sites of free anterolateral thigh flaps of 8 patients repaired with anteromedial thigh perforator flaps and donor sites of free anterolateral thigh flaps of 8 patients repaired with ilioinguinal flaps or superficial abdominal artery flaps, and donor sites of flaps of 20 patients repaired with peroneal perforator relaying flaps. Besides, wounds of 9 patients were repaired with free lobulated anterolateral thigh flaps, and wounds of 5 patients were repaired with modified V-Y propelling latissimus dorsi myocutaneous flaps. The donor sites of flaps were repaired with allogenic acellular dermal matrix combined with autologous split-thickness skin grafts in 10 cases. The areas of the flaps or myocutaneous flaps were ranged from 6.0 cm×4.0 cm to 30.0 cm×20.0 cm. The survival of flap, myocutaneous flap, or skin graft and the repair of donor site after operation and during follow-up were observed. Results: Blood flow obstacle at 0.5 cm to the distal margin of the flap occurred in 1 patient repaired with expanded flap, which were healed after dressing change. Blood supply disorder occurred at the tip of the anteromedial thigh perforator flap of 1 patient repaired by optimal flap design, which were healed completely after second debridement and restitching. The other flaps or myocutaneous flaps survived well. The allogenic acellular dermal matrix and the autologous split-thickness skin graft survived with good color and texture. During follow-up of 3 months to 4 years, the donor sites of flaps had good appearance, only with linear scar and the function recovered well. The donor sites of skin grafts had no scar hyperplasia, only with scattered pigmentation. Conclusions: According to the characteristics of donor sites of flaps, individualized and reasonable design before the operation such as pre-expanding of the flaps, selecting the ideal donor sites, optimization of the flap design or allogenic acellular dermal matrix combined with autologous split-thickness skin graft to repair donor sites of flaps can minimize the damage for function and appearance of donor sites of flaps and achieve aesthetic effects of donor sites of flaps.

Application of anteromedial thigh perforator flap in repair of soft tissue defects of lower limbs

To investigate effectiveness of anteromedial thigh perforator flap in repair of soft tissue defects of lower limbs. Between January 2015 and October 2018, 7 patients with soft tissue defects of the lower limbs were repaired with the anteromedial thigh perforator flaps. The patients were males, aged 8-30 years (median, 23 years). There were 5 cases of traffic accident injuries (the time from injury to admission was 1-4 hours, with an average of 1.5 hours), 1 case of scar formation after traffic accident, and 1 case of scar deformity after burn. The defect located in calf in 5 cases, foot in 1 case, and thigh in 1 case. The area of soft tissue defects ranged from 12 cm×4 cm to 21 cm×7 cm; and the area of flaps ranged from 14 cm×5 cm to 24 cm×8 cm. The donor sites were sutured directly. The flaps survived completely after operation in 6 cases, and the wounds healed by the first intention; the partial necrosis of flap occurred and healed after skin graft repair in 1 case. One incision partially ruptured in the donor site and healed after dressing change; the other incisions healed by the first intetion. All patients were followed up 6 months to 2 years with an average of 9 months. Except 1 case complained of edema of the flap, the other patients had good shape, good color, and no swelling. For patients with soft tissue defects of lower limbs that cannot be repaired with anterolateral thigh perforator flap, the anteromedial thigh perforator flap can be used for good results.

Relaying anterolateral thigh (ALT) perforator flap in resurfacing of the donor defect after anteromedial thigh (AMT) perforator flap transfer

Objective To introduce the clinical experience of relaying anterolateral thigh (ALT) flap in the resurfacing of the donor defect after anteromedial thigh (AMT) flap transfer. Methods From February 2014 to December 2015, 16 cases with oral carcinoma underwent radical resection, leaving tongue or mouth floor defects which were reconstructed by AMT perforator flaps. The flap size ranged from 7.5 cm×4.5 cm to 13.0 cm×7.5 cm [the patients was 45.6 years (range 31-72 years), body mass index (BMI) range 17.5-24.3 kg/m2]. Flaps' width was on average 6.6 cm (ranging from 5 to 9 cm) with flap width-to-thigh circumference ratio being 12.5% on average (ranging from 9.8% to 15.7%). The flap donor sites were reconstructed with relaying ALT flap at the same stage, the flap size ranged from 7.5 cm×4.0 cm to 12.0 cm×7.0 cm. Results The AMT and ALT perforators existed consistently in all cases of this serie. All free AMT flaps and relaying ALT flaps survived uneventfully. All patients were followed up for 8-24 months with satisfied esthetic and functional results in recipient and donor sites. 2-point discrimination distance of AMT flaps ranged from 7 to 14 mm, 2-point discrimination distance of relaying ALT flaps ranged from 8 to 15 mm, the function of thighs were not affected. Conclusions The relaying ALT flap is an ideal choice to reconstruct the donor site of free AMT flap. Key words: Surgical flaps; Thigh/SU; Cheek/SU; Skin transplantation

Reconstruction of ankle and foot with combination of free perforator flaps and skin graft

To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects. Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm. Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites. Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot.

The clinical application of free anteromedial thigh perforator flap in the reconstruction of tongue and mouth floor defect after tongue carcinoma

To investigate the application of free anteromedial thigh (AMT) perforator flap in the reconstruction of tongue defect after radical resection of tongue carcinoma. From September 2010 to January 2015,57 cases with tongue carcinoma underwent radical resection, leaving tongue and mouth floor defects which were reconstructed by AMT perforator flaps at the same stage. These 57 eases included tongue carcinoma at lingual margin (n =36),at ventral tongue (n =15) and at mouth floor (n=6). . The size of AMT perforator flap ranged from 5.5 cm ×4.0 cm to 7.5 cm × 5.5 cm, the thickness of flap ranged from 1.0-1.7 cm. The length of pedicle from descending branch of lateral circumferential femoral artery is (8.2 ± 0.6) cm, found in 28 cases. The length of pedicle from profunda femoral artery is (8.5 ±0.4) cm, found in 17 cases. The length of pedicle from femoral artery is (8.1 ± 0.7) cm, found in 12 cases. All 57 perforator flaps survived uneventfully, the defects at donor site were closed directly in all cases. All patients were followed up for 12-24 months with satisfactory esthetic and functional results in reconstructed tongue. No local recurrence happened. Only linear scar left in the donor sites, the function of thighs were not affected The free AMT perforator flap is an ideal choice for reconstruction of the tongue and mouth floor defect after radical resection of tongue carcinoma.

Outcome of relaying anterolateral thigh perforator flap in resurfacing the donor site wound following free anteromedial thigh perforator flap transfer for reconstruction of defect after oral tumor radical resection

Objective: To observe the outcome of relaying anterolateral thigh (ALT) perforator flap in resurfacing the donor site wound following free anteromedial thigh (AMT) perforator flap transfer for reconstruction of defect after oral tumor radical resection. Methods: From January 2013 to January 2016, 28 patients with oral tumor underwent radical resection in our hospital, leaving defects with size ranged from 6.5 cm×3.5 cm to 11.0 cm×7.5 cm which were reconstructed by free AMT perforator flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm. All the arteries of AMT perforators were anastomosed with superior thyroid arteries, while the venae comitants were anastomosed with superior thyroid venae or internal jugular venae. The donor site wounds of free AMT perforator flaps were reconstructed by relaying ALT perforator flaps with size ranged from 8.0 cm×3.5 cm to 14.0 cm×7.5 cm. The relaying ALT perforator flap and wound edge were closed directly with layer interrupted suture. Postoperatively, the patients stayed in bed and received diet through nasal feeding tube, and the ordinary diet and lower extremity exercise were carried out from one week after operation. Results: The AMT and ALT perforators existed consistently in all patients. In 16 patients the venae comitants of AMT perforator arteries were anastomosed with superior thyroid venae in end-to-end fashion, while in 12 patients with internal jugular venae in end-to-side fashion. All flaps survived uneventfully about 2 weeks after operation, and the wounds healed smoothly. All patients were followed up for 6 to 30 months after operation. The sites repaired with free AMT perforator flaps were not bulky in appearance, with two-point discrimination distances ranged from 8 to 15 mm. The movement of tongue was not obviously affected, and patients could speak and eat normally. The texture and color of the sites repaired with relaying ALT perforator flaps were close to those of the adjacent tissue, and the two-point discrimination distances of the sites repaired with relaying ALT perforator flaps were ranged from 7 to 12 mm. The function of thigh was not obviously affected, and patients could walk normally and do related daily activities. Conclusions: Reconstruction of defect after oral tumor radical resection with free AMT perforator flap can achieve good outcome, and wound in the donor site of free AMT perforator flap repaired with relaying ALT perforator flap can achieve good appearance and function recovery.

Clinical application of relaying anteromedial thigh perforator flap in resurfacing of donor defect after anterolateral thigh flap transfer

To investigate the clinical application of relaying anteromedial thigh (AMT) perforator flap in resurfacing of the donor defect after anterolateral thigh (ALT) flap transfer. Between February 2012 and December 2015, 23 cases of oral carcinoma underwent radical resection; after resection of lesions, the tongue or mouth floor defects were reconstructed by ALT perforator flaps, and the donor sites were repaired with relaying AMT perforator flap at the same stage. There were 21 males and 2 females,with a mean age of 52.6 years (range, 29-74 years). Sixteen patients had tongue squamous cell carcinoma and 7 patients had buccal cancer. According to TNM tumor stage, 3 cases were classified as T 4N 0M 0, 5 cases as T 4N 1M 0, 7 cases as T 3N 1M 0, 5 cases as T 3N 2M 0, and 3 cases as T 3N 0M 0. The disease duration ranged from 6 to 18 months (mean, 8.8 months). The AMT perforators existed consistently in all patients. All flaps survived, and primary healing of wounds was obtained at recipient sites and donor sites. No vascular crisis, wound dehiscence, or obvious swelling occurred. All patients were followed up 6-20 months (mean, 9.4 months). There was only linear scar at the donor sites, and the function of thighs was normal. The color and contour of the flaps were satisfactory. The relaying AMT perforator flap is an ideal choice to reconstruct the donor site of ALT flap.

Free anteromedial thigh perforator flap: Complementing and completing the anterolateral thigh flap.

Objective:Theobjective of this study was to determine the indications, utility, advantages and surgical approach for the anteromedial thigh (AMT) flap.Materials and Methods:We reviewed the records of the patients in whom the AMT flap was used for head and neck reconstruction. We use an anterior approach to harvest the anterolateral thigh (ALT) flap with a non-committal straight line incision. This preserves both ALT and AMT flap territories intact, and further decision is based on the intraoperative anatomy of perforator and pedicle. The ALT flap was usually used as the first choice when available and suitable.Results:Free AMT skin flaps were harvested in 24 patients. All flaps were used for the head and neck reconstruction. Two flaps had marginal flap necrosis. One flap was lost due to venous thrombosis.Discussion:The thigh is an excellent donor site as it has large available skin territory, expendable lateral circumflex femoral artery system and low donorsite morbidity. The ALT flap is the most commonly used flap for reconstruction of soft-tissue defects. However, it is characterised by variable vascular pedicle and perforator anatomy. The AMT flap is an excellent alternative when the ALT flap is not available due to variable perforator anatomy, injury to perforator, when an intermediate thickness is needed between distal and proximal thigh or a chimeric flap is needed.Conclusion:The AMT flap offers all the advantages of the ALT flap without increasing donor-site morbidity. The anterior non-committal approach keeps both the ALT and the AMT flap options viable.

Use of anteromedial thigh perforator flap and immunological implications of Gorlin-Goltz syndrome: a case study

Gorlin-Goltz syndrome is mainly characterised by the development of numerous multicentric and relapsing cutaneous basal cell carcinomas (BCCs). A major problem for patients with Gorlin-Goltz syndrome is the large amount of BCCs that can invade the deep underlying structures, especially the face. Here, we describe the case of a 23-year-old male affected by Gorlin-Goltz syndrome. He had recurrent BCCs on a hairless scalp and dorsum since he was 17 years old and underwent four surgical procedures to excise BCCs, including a reconstruction with anteromedial thigh perforator flap. For each of the surgical procedures, a phenotypic study on peripheral blood mononuclear cells using flow cytometry was performed on the same day of surgery, and on days 7, 14 and 21 after surgery. The role of the tumour-specific cytolytic immune response as a potential future treatment of syndromic BCCs and its trend in relation to surgical ablation of large portions of tumour tissue was examined, and the cosmetic and therapeutic results are shown.

Clinical application of anteromedial thigh perforator flap for coverage of anterolateral thigh flap donor site

Objective To investigate the clinical outcomes of repairing the donor site of anterolateral thigh (ALT) flap by a V-Y flap pedicled with anteromedial thigh perforator.Methods From June 2012 to March 2013,6 cases of skin defects in the foot or hand were treated with anterolateral thigh flap.The donor site in these cases was simultaneously repaired with a V-Y flap pedicled with anteromedial thigh perforator.Results All the anterolateral thigh flaps survived uneventfully.Five of the 6 perforating branch V-Y flaps survived,while 1 flap had partial necrosis at the distal end of the flap which healed by dressing change.The patients were followup for 3 to 6 months,with an average of 4 months.The appearance and the texture of the flaps were good.The anterolateral thigh donor area wound healing was leveled with even skin tone.Quadriceps muscle strength and knee movement were normal.There was no numbness of the V-Y flap.Conclusion This procedure is easy and effective.The treatment outcome is satisfactory.It is an improvement over traditional methods to treat donor site defects upon anterolateral thigh flap harvest. Key words: Surgical flaps; Wounds and injuries; Perforator

Anteromedial thigh perforator-assisted closure of the anterolateral thigh free flap donor site

Primary closure of the anterolateral thigh free flap donor site is advisable as skin grafting can be associated with higher morbidity. However, this is not possible when anterolateral thigh free flap width is over 8-9 cm with a corresponding flap width-to-thigh circumference ratio over 16%. The authors report their experience and technique with the anteromedial thigh perforator dissection during anterolateral thigh free flap donor-site closure that, on demand, can be used to design a local perforator flap to achieve primary closure of the donor site. Between July and December 2012, 20 consecutive patients underwent elective anterolateral thigh free flap reconstruction for head and neck oncologic surgery. Attempts to close directly the anterolateral thigh free flap donor site failed in two patients with large flaps and V-Y anteromedial thigh perforator flaps were advanced to close the defect. Flaps healed uneventfully. Except two patients, at least one>1-mm perforator was found in all the remaining thighs. Further investigation is needed to establish the maximum anterolateral thigh free flap donor-site width that can be served by this reconstruction. This represents an ideal model for residents to start training on perforator dissection.

Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck

The anteromedial thigh (AMT) perforator flap is usually thin, pliable, and nearly hairless, making it particularly suitable to repair defects of the head and neck. We studied the topography and outcomes of AMT perforator flaps in such defects after excision of tumours. We retrospectively reviewed the casenotes of 11 consecutive patients who had had reconstructions of the head and neck with the initial intent of using an AMT perforator flap from January 2010 to July 2011. For each patient we recorded the size and thickness of the flap; the length of the pedicle; and the number, external diameters, anatomical types, source vessels, and sites of the sizeable perforators. Of the 11 patients, 10 had successful reconstruction using AMT perforator flaps, but one had no AMT perforator big enough. The mean (range) number of sizeable perforators/flap was 1.3 (1–2), length of pedicle 10.6 (7–13) cm, and diameter of the artery 1.1(1.0–1.5) mm. Of the 13 sizeable perforators, 3 were direct and septocutaneous. The remaining ones were all musculocutaneous. Most of them were located in the middle third of the thigh. Primary closure of the donor site was achieved in all patients. One flap was successfully revised after compression of the perforator. All flaps survived with good functional and aesthetic outcomes. The free AMT perforator flap is suitable for reconstructions of the head and neck if a sizeable perforator can be found. The AMT flap may be used as a primary flap rather than as an alternative to the anterolateral thigh flap or a component of a chimeric flap.

093. Anteromedial thigh perforator flap: Review of 40 cases

093. Anteromedial thigh perforator flap: Review of 40 cases

Reconstruction of soft-tissue defects in foot using free graft of perforator flap

Objective To discuss the clinical effects of reconstruction of soft-tissue defects in foot using free graft of perforator flap. Methods From March 2006 to December 2009, 4 kinds of free graft of perforator flap form the lower extremity were used for reconstruction of soft-tissue defects in foot in 20 cases.They were 15 males and 5 females. Their ages ranged from 18 to 61 years old, with an average of 28. 5 years.Seven cases had defects in the left foot and 13 in the right. The defects were located in the dorsal foot in 12cases, the heel in 5 and ankle in 3. Five were reconstructed with anterolateral thigh perforator flaps, 7 with anteromedial thigh perforator flaps, 5 with superficial peroneal artery perforator flaps and 3 with peroneal artery perforator flaps. The defect areas ranged from 2.0 cm × 3.5 cm to 12. 0 cm × 18. 0 cm. Results All the flaps survived. Intraoperative vascular crisis occurred in 2 cases but the blood flow was restored after timely treatment. Follow-ups of 3 to 6 months showed all the flaps had a good appearance. Thirteen cases restored a good protective sensibility after nerve anastomosis. The donor sites healed well without sacrifice of their normal function. Conclusion Free graft of perforator flap is an effective method to reconstruct soft-tissue defects in foot. Key words: Foot injuries; Surgical flaps; Skin transplantation

The Anteromedial Thigh Flap as a Training Model of a Perforator Flap in Rat

Perforator flap surgery is a complex surgery that is based on the use of a highly precise microsurgical technique that differs slightly from a conventional free flap, especially the intramuscular dissection of the pedicle. Herein, we report a new model of a perforator flap in rat, the anteromedial thigh flap, as a teaching model of a perforator flap. It is based on a constant musculocutaneous perforator that arises from the muscular vessels for the gracilis muscle. Twenty Wistar rats were used in this study. In 10 rats, an anatomical study was performed by means of anatomical dissection, Chinese ink injection, and microangiography studies, and in 10 rats, a flap transplantation study was carried out by means of transferring a pedicled perforator flap to the abdomen and monitoring its viability by direct inspection on the seventh day. Anatomical studies revealed a constant perforator that has an average length of pedicle up to 20 mm, an external diameter from 0.2 to 0.3 mm, and supplies blood to an area of approximately 3 x 3 cm of the anteromedial region of the thigh. In the flap studies, all the flaps survived on the seventh day after operation. The anteromedial thigh perforator flap is a reliable, reproducible inexpensive, replicates the handling of a perforator flap very closely, and has an easy method to record the outcomes by visual inspection, so we think that it is a useful tool as a teaching model for training a perforator flap in the preclinical setting.

The ‘propeller’ distal anteromedial thigh perforator flap. Anatomic study and clinical applications

The leg and peripatellar region have always been known as a poor source of available flaps. One flap donor site that has proven to be adequate is the distal anteromedial half of the thigh. Due to the potential and plentiful vascular sources of this anatomic region we decided to study the distal anteromedial thigh and its clinical applications. ANATOMIC STUDY: Sixteen cryopreserved inferior limbs were latex-injected in the femoral artery and the skin perforators of the distal anteromedial thigh and their source vessels were studied. In a period between December 2000 and June 2005, skin islands from the distal anteromedial aspect of the thigh of six patients were transferred, as local perforator flaps, to reconstruct the peripatellar region and upper leg soft tissue defects. Every flap was based on a single adequate perforator vessel. The tissue was rotated, as a 'propeller', through 180 degrees and the flap was named 'the propeller distal anteromedial thigh perforator flap'. In the distal anteromedial thigh the anatomic variability includes not only perforator vessels but also their source vessels. Skin perforators can come from each of the deep vessels. Our clinical results, with a follow up of 1-4 years, show no total flap losses. Partial necrosis > 20% happened in one diabetic patient. The propeller distal anteromedial thigh perforator flap can be reliably transferred based on only one adequate perforator vessel. It reduces the morbidity and improves the availability of the distal anteromedial thigh as a flap donor site and represents an additional reconstructive option for knee and upper leg defects.

The free gracilis perforator flap for autologous breast reconstruction

The free gracilis perforator flap is an alternative possibility for autologous breast reconstruction, if previous abdominal operations preclude this donor site, or if there is atypical distribution of fat tissue. The perforator flap is based on the main pedicle of the gracilis muscle. The muscle itself and its innervation can be completely preserved, if the angiosome of this vascular pedicle offers sufficient tissue. In skinny patients however it may be necessary to include the neighbouring angiosome of the second gracilis pedicle by means of the intramuscular anastomosis between both pedicles. In such a case a thin muscle strip with the joining vessel must be included in the flap. The bulk of the gracilis muscle and its motor nerve can, however, still be preserved. Breast reconstruction with this technique was successfully performed on six patients (two bilateral). It is a good alternative to a reconstruction with gluteal, or anteromedial, or lateral thigh perforator flaps.