The Applied Anatomic Study On The Free Flap With The First Profunda Perforator Artery

[Objective]A microsurgical anatomic research was promoted on 10 fresh cadavericspecimens by observing the start and end point, the course, the branches, theouter diameter, the accompanying vein, and the blood-supply area of theposterior femoral cutaneous branch of the descending branch of the firstprofunda perforator artery (1PPA) to provide anatomic basis for the free flapwith this branch.[Methods]10 fresh cadaveric lower limbs were injected through the femoral arteryusing the cochineal latex and stored in the ice tank. Before dissection, thespecimens were left at the room temperature (10~15℃) for 8~10 hours. Thesespeciments were dissected under operating loupe to observe the start and endpoint, the course, the branches, the outer diameter, the accompanying vein, andthe blood-supply area of the 1PPA, and design a free flap with the 1PPA. [Results]The distance between the linea poplitea and the level of the greatertrochanter was 352.74 mm±28.82 mm. The 1PPA was found in 10 specimens(100%), and every of them arose from the profunda femoris artery. The distancebetween the start point of the 1PPA and the level of the greater trochanter was78.00 mm±10.82 mm. The 1PPA divided into ascending and descendingbranches after perforating from the adductor magnus. The descending branchgave out a branch to the long head of the biceps femoris on the level of 141.85mm±14.87 mm distal to that of the greater trochanter, and to the sciatic nerve188.97 mm±34.64 mm. The descending branch gave out 1 to 4 muscularbranches to the semimembranosus. The distal posterior femoral cutaneousbranch of the descending branch (DPFCD) was given out on the level of 226.84mm±51.09 mm distal to that of the greater trochanter. 80% of these branchespassed between the biceps femoris and semimembranosus, and 20% of themperforated the long head of the biceps femoris. The outer diameter of theDPFCD was 0.64 mm±0.08 mm when perforated the deep fascia on the levelof 264.12 mm±20.30 mm distal to that of the greater trochanter. The DPFCDdivided into ascending and descending branches on the level of 270.09 mm±22.53 mm distal to that of the greater trochanter; the outer diameter of the startpoint of the ascending branch was 0.35 mm±0.07 mm, and that of thedescending branch was 0.33 mm±0.05 mm. The proximal posterior femoralcutaneous branch of the descending branch (PPFCD) was found in 10 specimens (100%). 20% of the PPFCD arose from the ascending branch of the 1PPA, 50%from the descending branch of the 1PPA and 30% of them originated in commontrunk with the DPFCD.It was detected with microdissection that the ascending and descendingbranches of the DPFCD supply blood to a scope with a major axis of 89.58 mm±7.60 mm, and a minor axis of 46.00 mm±6.33 mm. The PPFCD inferiorperforated the gluteal skin.The PPFCD was accompanied by two vein, which joined the accompaniedof the descending branch of the 1PPA and finally joined the deep femoral vein.[Conclusions]The axises point of the free flap with the 1PPA are 27 cm and 10 cm distalto the level of the greater trochanter on the midline of posterior thigh, the axisline of the flap is on the mid-line of the posterior thigh, and the supply scope ofthe flap is 20 cm×11 cm.