Anatomical study of the popliteal artery perforator-based propeller flap and its clinical application

Background: There is lack of anatomical information regarding cutaneous perforator of the popliteal artery and its connections with the descending branch of the inferior gluteal and profunda femoris arteries. We aimed to evaluate the anatomical basis of popliteal artery perforator-based propeller flap from the posterior thigh region and to demonstrate our experience utilizing this flap. Methods: Ten fresh cadaveric lower extremities were dissected following injection of a silicone compound into the femoral artery. We investigated the number, location, length, and diameter of cutaneous perforators of the popliteal artery. Based on the results, we treated three cases with a large soft tissue defect around the knee using popliteal artery perforator-based propeller flap. Results: We found a mean of 1.9 cutaneous perforators arising from the popliteal artery with a mean pedicle length of 6 cm and a mean arterial internal diameter of 0.9 mm, which were located at an average of 4 cm proximal to the bicondylar line. The most distal perforator consistently arose along the small saphenous vein and connected proximally with concomitant artery of the posterior femoral cutaneous nerve, forming a connection with perforating arteries of the profunda femoris artery. A mean of 4.5 cutaneous perforators branched from the arterial connection sites. All clinical cases healed without any complications. Conclusion: The popliteal artery perforator-based propeller flap is reliable for reconstruction of soft tissue defects around the knee. The flap should include the deep fascia and concomitant artery along with the posterior femoral cutaneous nerve for maintaining the blood supply. Financial Disclosure and Products: Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Authors' Roles/Participation in Authorship of Manuscript: Tadanobu Onishi contributed to the clinical treatment of the patients, anatomical study, and data interpretation. Takamasa Shimizu contributed to the clinical treatment of the patients, anatomical study, and data interpretation. Shohei Omokawa contributed to the clinical treatment of the patients, anatomical study, and data interpretation. Kanit Sananpanich contributed to the clinical treatment of the patients, anatomical study, and design of the figures. Akira Kido contributed to the clinical treatment of the patients and data interpretation. Pasuk Mahakkanukrauh contributed to the anatomical study. Yasuhito Tanaka contributed to data interpretation. All authors approved the final version of the manuscript and have agreed to be accountable for all aspects of the study. Acknowledgements: The authors would like to thank Kanya Honoki, M.D., Hiromasa Fujii, M.D., Yasuaki Nakanishi, M.D., Tsutomu Kira, M.D., Shinji Tsukamoto, M.D., and Naoki Hayami M.D. for their valuable assistance with the clinical treatments. The authors also thank the staff of the Department of Orthopedic Surgery and the Surgical Training Center at Chiangmai Medical University for their valuable assistance with the special liquid activated in this study. Corresponding Author Contact Information: Takamasa Shimizu, M.D., Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan. E-mail: tk-shimi@naramed-u.ac.jp ©2018American Society of Plastic Surgeons

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