The Angiosomes of the Thigh and Buttock

Background: The angiosomes of the body were defined in 1987. The recent popularity of skin perforator and muscle flaps designed in the thigh, together with significant major vessel anomaly and disease, has necessitated a more detailed reevaluation of the blood supply to this region. Methods: Eighteen new studies, combined with a review of 36 of the authors' archival studies of the buttock and the thigh, have been conducted in fresh human cadavers using arterial perfusion with a radiographic lead oxide mixture. Results: The angiosome territories of the lumbar, deep circumflex iliac, sacral, gluteal, common femoral, superficial femoral, lateral femoral circumflex, medial femoral circumflex, profunda, descending genicular, and popliteal source vessels that contribute to the thigh and buttock were defined between the skin and the bone. The dominant cutaneous supply of perforators of 0.5 mm or greater emerged from the deep fascia predominantly in longitudinal rows from the intermuscular septa or from intramuscular septa, especially from the buttock muscles. Each muscle was supplied from two or more angiosomes, thereby constituting important bypass shunts for potential major vessel injury or disease, by means of their intramuscular anastomoses. Conclusions: These results may help the surgeon in the design of skin perforator and refined muscle, musculocutaneous, and composite flaps in the thigh and the buttock. The study also provides for a better understanding of vessel anastomoses in the region. (Plast. Reconstr. Surg. 123: 236, 2009.)