Objective To provide the anatomical basis for posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator. Methods A total of 30 embalmed lower limbs of adult cadavers perfused with red latex were dissected and measured to observe the course and distribution of posterior femoral cutaneous nerve (PFCN), and the anastomoses between direct popliteal artery perforator and nutrient vessels of PFCN. Mimic operation was performed on 1 side of fresh specimen. Results PFCN started from the midpoint of the inferior gluteus maximus edge, and went down along the middle line of posterior thigh region, and the final trunk of PFCN accompanied with small saphenous vein down to the middle line of lower leg. The diameters of PFCN was (3.0 ± 0.6) mm at the inferior gluteus maximus edge, and was (2.0 ± 0.7) mm at the superior fossa poplitea. The nutrient vessels of PFCN were multi-segmental and polyphyletic. The direct popliteal artery perforator which started from popliteal artery directly was constant pierced into deep fascia about 7-11 cm above the knee joint, and its original diameter was (0.8 ± 0.2) mm. The direct popliteal artery perforator had 1-2 accompanying veins, and this perforator artery was the main nutrient vessel of the inferior segment of PFCN. The direct popliteal artery perforator gave off 5-8 small vessels which anastomosed with the 1st-3rd perforator of deep femoral artery, the obturator artery perforator, and the lateral femoral circumflex artery perforators. Then these nutrient vessels formed vascular plexus along PFCN in the middle line of posterior region of thigh. Mimic operation showed that the posterior femoral neurocutaneous vascular flap pedicled with direct poplitea artery perforator could be formed successfully. Conclusion The posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator has constant blood supply and can be easily formed to repair defects around knee joint.
Objective To explore the clinical value of repairing extensive gluteal-sacral defects with the posterior femoral cutaneous neurovascular island flap. Methods From July 2002 to May 2005, the posterior femoral cutaneous neurovascular flap was applied to repairing extensive gluteal-sacral defects in 6 patients (3 males, 3 females; aged 31-59 years). Threepatients had a skin defect in the gluteal-sacral region caused by squamous cell carcinoma, 1 patient had the defect in the same region caused by malignant fibrohistiocytoma, and 2 patients had the defect caused by bedsores of grade Ⅲ. The area of defects ranged from 15 cm×8 cm to 16 cm×10 cm.The flaps rangedin area from 15 cm×8 cm to 18 cm×10 cm. Results In all the 6 patients had their flaps survived well and the wounds gainedthe primary healing. The follow-up for 2.5-12 months revealed that, flaps were satisfactory in their appearance, texture, and sensory functions. Conclusion The repair of extensive gluteal-sacral defects with the posterior femoral cutaneous neurovascular island flap has advantages of the unchangedanatomic structures, reliable blood supply, easy dissection for extensive defects, good sensory recovery, and sacrificing no major vessels; therefore, this kind of repair is an optimal approach to repairing extensive glutealsacral defects.