title: Biceps femoris musculocutaneous flap for reconstruction of refractory ulceration at the popliteal fossa.
abstract: BACKGROUND
  There is a lack of information about the possibility of transfer of the long head of the biceps femoris (LHBF) musculocutaneous flap to the knee area. We discuss the use of the LHBF musculocutaneous flap to treat refractory ulceration at the popliteal fossa and the results of a preliminary study investigating the anatomical possibility of transferring this flap to the popliteal region.
  
  
  METHODS
  Five lower extremities of 5 fresh cadaveric specimens were dissected following injection of a silicone compound into the deep femoral artery. We investigated the number, location, and diameter of nutrient branches to the LHBF originating from the deep femoral artery. Based on these results, we treated a 76-year-old woman with a refractory postradiation ulcer at the popliteal fossa associated with popliteal artery obstruction using a 25 × 7 cm LHBF musculocutaneous flap.
  
  
  RESULTS
  The mean number of nutrient branches to the LHBF muscle was 3.6, with a mean diameter of 1.9 mm. One to two branches consistently arose from the distal aspect of the posterior thigh. Most branches followed an intramuscular route, giving rise to fine cutaneous branches. The distal border reached by the musculocutaneous flap was located 6.7 cm distal to the bicondylar line. The flap survived completely without complications, and the patient was able to walk with a walking frame postoperatively.
  
  
  CONCLUSIONS
  The LHBF musculocutaneous flap may offer a reliable treatment option for soft-tissue defects of the popliteal fossa, especially in patients with significant damage to the popliteal artery from trauma or radiation therapy.
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Chiangmai Medical University, Chiangmai, Thailand; and Department of Orthopedic Surgery, Nara Municipal Hospital, Nara, Japan.
authors.forename: Tadanobu
authors.initials: T
authors.lastname: Onishi
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Chiangmai Medical University, Chiangmai, Thailand; and Department of Orthopedic Surgery, Nara Municipal Hospital, Nara, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Omokawa
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Chiangmai Medical University, Chiangmai, Thailand; and Department of Orthopedic Surgery, Nara Municipal Hospital, Nara, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Chiangmai Medical University, Chiangmai, Thailand; and Department of Orthopedic Surgery, Nara Municipal Hospital, Nara, Japan.
authors.forename: Kanit
authors.initials: K
authors.lastname: Sananpanich
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Chiangmai Medical University, Chiangmai, Thailand; and Department of Orthopedic Surgery, Nara Municipal Hospital, Nara, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Chiangmai Medical University, Chiangmai, Thailand; and Department of Orthopedic Surgery, Nara Municipal Hospital, Nara, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kira
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Chiangmai Medical University, Chiangmai, Thailand; and Department of Orthopedic Surgery, Nara Municipal Hospital, Nara, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Murata
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Chiangmai Medical University, Chiangmai, Thailand; and Department of Orthopedic Surgery, Nara Municipal Hospital, Nara, Japan.
authors.forename: Kanya
authors.initials: K
authors.lastname: Honoki