Le lambeau perforant de l’artère fémorale profonde : une étude anatomique morphométrique

Background. - Within the framework of mammary reconstruction, since 2012 when Allen first described it, the profunda femoral artery perforator flap (PAP) takes an important place in the current therapeutic options. Objective. - This anatomical study aims to analyze the anatomy and morphologic consideration of the PAP : position of the perforating artery; length of the pedicle, area and volume of vascularization. Methods. - Sixteen flaps were harvested on fresh subjects at the University Department of Anatomy of Rockfeller, Lyon. The first direct cutaneous branch from the deep femoral vessels was located between or through the adductor magnus and gracilis muscles. Pedicle location, diameter, length and position regard to the great saphenous vein were recorded. A flap based on this vessel was designed. Height, width, and surface of the skin paddle were recorded. Three-dimensional computed tomographic angiography was used to analyze the area and volume of cutaneous territory supplied by the studied perforator. Results. - On the 16 analyzed flaps, localization of the perforating artery is on average to 8.2 cm of the pubic tuber and 3.7 cm behind a line connecting the pubic tuber to the internal femoral condyle. The length of the pedicle is on average of 11.7 cm and the average area of skin perfused was 94,68 cm(2) . The way of this perforating arterty is primarily through the adductor magnus. On the radiological images of the 8 flaps, the analysis shows an average surface of 111,25 cm(2) and a mean volume of 325.3 cm(3). Discussion. - PAP is an interesting therapeutic choice within the framework of a mammary reconstruction. Its surface and its volume associated with a discrete scar make a valid indication within the framework of this surgery. (C) 2019 Published by Elsevier Masson SAS.