Perforator Patterns of the Anteromedial Thigh Flap

Background: The vascular anatomy of the anteromedial thigh flap has not been well defined. The purpose of this study was to determine the perforator patterns and vascular anatomy of this flap. Methods: The perforators of the anteromedial thigh flaps and their origins were prospectively explored, documented, and mapped. Results: Twenty-one of 100 thighs had no anteromedial thigh perforators. For the remaining thighs, there were two sources of perforators: the rectus femoris branch of the descending branch of the lateral circumflex femoris artery, and the superficial femoral artery. Perforators from the latter were short and small and thus less useful. Anteromedial thigh flaps based on rectus femoris branch perforators shared the same vascular pedicle as the anterolateral thigh flap and were thus clinically useful. These rectus femoris branch perforators, however, were present in only 51 percent of the patients. Their surface locations follow a similar pattern as the anterolateral thigh flap, with the majority of perforators near the midpoint, but an average of 3.2 cm medial to a line connecting the anterior superior iliac spine and the superolateral patella. Forty-three thighs had a single rectus femoris branch perforator and eight had two perforators. Sixty-six percent were septocutaneous and the rest traversed a thin layer of the rectus femoris muscle. Conclusions: The perforator patterns of the anteromedial thigh flap were examined and defined. It is best to plan the anteromedial thigh flap to complement the anterolateral thigh rather than to be the primary flap. (Plast. Reconstr. Surg. 128: 151e, 2011.)