Cadaveric study for safe elevation of a profunda artery perforator (PAP) flap: Anatomy of the perforators and obturator nerves.

BACKGROUND: This study aimed to describe the anatomy of the profunda artery perforators using a fresh cadaver.

METHODS: In total, nine free cadavers with 18 upper thighs were dissected. Twelve were female, and six were male. The average age was 84.7±4.2 years. Dissection was performed to evaluate the anatomic position and characteristics of perforators from the profunda femoral artery perforators. The perforator distance from the gluteal sulcus, number of perforators, perforating muscles, diameter of the perforators, origin of the perforators, and number of nerves passing above and below the perforators were determined.

RESULTS: The average number of perforators that penetrate the adductor magnus muscle was 2.5. The average distance from the origin of the perforators to the gluteal sulcus was 71.72±28.23 mm. The average number of the obturator nerves passing above and below the perforator in the adductor magnus muscle was 1.3 (range, 0-4) and 0.7 (range 0-2), respectively.

CONCLUSIONS: The data presented in this article provide a detailed anatomic basis for the profunda artery perforator (PAP) flap. The perforators of a PAP flap could possibly be included in a flap with a transverse design. It seems that sacrificing the small obturator nerves during dissection may not lead to significant donor site morbidity.