Abstract
Background A chimerically configured gracilis and profunda artery perforator (PAP) flap is highly
prevalent based on recent computed tomography (CT)-imaging data. The purpose of this
study is to further characterize the vascular anatomy of this novel flap configuration
and determine the feasibility of flap dissection.
Methods To characterize flap arterial anatomy, lower extremity CT angiograms performed from
2011 to 2018 were retrospectively reviewed. To characterize venous anatomy and determine
the feasibility of flap harvest, the lower extremities of cadavers were evaluated.
Results A total of 974 lower extremity CT angiograms and 32 cadavers were included for the
assessment. Of the 974 CT angiograms, majority (966, 99%) were bilateral studies,
yielding a total of 1,940 lower extremities (right-lower-extremity = 970 and left-lower-extremity = 970)
for radiographic evaluation. On CT angiography, a chimerically configured gracilis
and PAP flap was found in 51% of patients (n = 494/974). By laterality, chimeric anatomy was present in 26% of right lower extremities
(n = 254/970) and 25% of left lower extremities (n = 240/970); bilateral chimeric anatomy was found in 12% (n = 112/966) of patients. Average length of the common arterial pedicle feeding both
gracilis and PAP flap perforasomes was 31.1 ± 16.5 mm (range = 2.0–95.0 mm) with an
average diameter of 2.8 ± 0.7 mm (range = 1.3–8.8 mm).
A total of 15 cadavers exhibited chimeric anatomy with intact, conjoined arteries
and veins allowing for anatomical tracing from the profunda femoris to the distal
branches within the tissues of the medial thigh. Dissection and isolation of the common
pedicle and distal vessels was feasible with minimal disruption of adjacent tissues.
Chimeric flap venous anatomy was favorable, with vena commitante adjacent to the common
pedicle in all specimens.
Conclusion Dissection of a chimeric medial thigh flap consisting of both gracilis and PAP flap
tissues is feasible in a cadaveric model. The vascular anatomy of this potential flap
appears suitable for future utilization in a clinical setting.
Keywords
chimeric flap - medial thigh - cadaver dissection
