RECONSTRUCTIVE The Posterior Thigh Perforator Flap or Profunda Femoris Artery Perforator Flap Reza Ahmadzadeh, B.Sc. Leonard Bergeron, M.D., C.M. Maolin Tang, M.D. Christopher R. Geddes, M.Sc. Steven F. Morris, M.D., M.Sc. Halifax, Nova Scotia, Canada Background: The thigh donor site has been used extensively for microsur- gical tissue transfer; however, the posterior thigh has been neglected as a potential donor site. The perforators of the profunda femoris artery supply large cutaneous territories that could be useful for lower extremity coverage. The purpose of this article is to evaluate the anatomical basis of the posterior thigh perforator flap and to provide anatomical landmarks with which to facilitate flap dissection. Methods: Six fresh cadavers underwent a whole-body, intraarterial injection of a lead oxide and gelatin preparation. The integument of the posterior thigh was dissected (n = 11), and perforators of the profunda femoris artery were identified. Their type (septocutaneous versus musculocutaneous), course, size, and location were documented by angiography and photogra- phy. Surface areas were measured with Scion Image Beta 4.02. Results are reported as mean  SD. Results: The average number of profunda femoris cutaneous perforators in the posterior thigh was 5  2 (65 percent septocutaneous and 35 percent musculocutaneous), the average internal diameter was 0.8  0.3 mm, and the pedicle length was 29  14 mm from the deep fascia and 68  33 mm from the profunda femoris artery. The average profunda femoris cutaneous vas- cular territory was 229  72 cm 2 , with a 46  13-cm 2 perforator zone. Cutaneous perforators can be found on a line extending from the ischium to the lateral femoral condyle. Conclusions: The profunda femoris provides cutaneous perforators of large caliber supporting a substantial cutaneous territory. This flap will likely be clinically useful in lower extremity reconstruction as a free or pedicled flap. (Plast. Reconstr. Surg. 119: 194, 2007.) T he use of perforator flaps has become popu- lar in reconstructive microsurgery. The thigh donor site, as in the anterolateral thigh flap, 1 has been used extensively for microsurgical tissue transfer. Interestingly, the posterior aspect of the thigh has been somewhat neglected as a potential donor site. It appears that the clinical application of flaps in this area has been limited by the con- flicting anatomical descriptions of the area and the different nomenclature schemes used. The poste- rior thigh flap was first described in 1980 by Hurwitz. 2 It was transferred as a free flap by Song et al. in 1984, 3 and it has been used as a pedicled flap, 4 a pedicled island flap, 5 and a free flap. 3,5 The posterior thigh perforator flap based on perfora- tors of the profunda femoris artery could be useful for lower extremity coverage. However, inadequate anatomical information is currently available with which to assess this flap. The posterior thigh region is loosely defined as a region bordered by the inferior gluteal fold superiorly, the iliotibial tract laterally, the thigh adductors medially, and the popliteal fossa infe- riorly. The main muscles of the posterior thigh are the hamstring muscles (biceps femoris, semi- tendinosus, and semimembranosus), which are supplied by the profunda femoris artery. Flaps from the posterior thigh have been based on either the descending branch of the inferior gluteal artery 2,6–8 or the profunda femoris artery. 3–5,9,10 The descending branch of the infe- rior gluteal artery, 6,11,12 when present, 11 travels with the posterior cutaneous nerve of the thigh From the Department of Anatomy and Neurobiology and Department of Surgery, Dalhousie University. Received for publication July 4, 2005; accepted October 24, 2005. Presented at the Canadian Society of Plastic Surgeons An- nual Meeting, in Nanaimo, British Columbia, Canada, June 9, 2005. Copyright ©2006 by the American Society of Plastic Surgeons DOI: 10.1097/01.prs.0000244848.10434.5f www.PRSJournal.com 194