Breast reconstruction using free posterior medial thigh perforator flaps: Intraoperative anatomical study and clinical results

Background: The free posterior medial thigh perforator flap is a fasciocutaneous flap on the posterior and medial thigh, based on perforators from the deep femoral vessels. In this study, the authors evaluated the anatomical basis of posterior and medial thigh perforators from the deep femoral vessels. Methods: Between June of 2006 and May of 2012, 67 patients underwent breast reconstruction using the posterior medial thigh flap. Perforators greater than or equal to 0.5 mm in this region were investigated. The following parameters were recorded intraoperatively: number of perforators, perforator diameters, perforator locations, pedicle length, and distance of the perforating point from the proximal thigh crease. Results: Of 70 flaps, 69 survived, but one developed total necrosis. The total number of perforators was 272, and the mean number was 3.9. The number of perforators coursing through the adductor magnus muscle was largest, followed by those coursing between the adductor magnus and semimembranosus muscle septocutaneously. Musculocutaneous perforators from the adductor magnus were located more proximally than the septocutaneous perforators between the adductor and semimembranosus muscle. Conclusions: The posterior medial thigh flap is suitable as a first-line option for breast reconstruction in women with a small to moderate breast size. This flap provides enough large perforators to support a soft-tissue transfer from the posterior and medial thigh.