Breast reconstruction using free medial circumflex femoral artery perforator flaps: intraoperative anatomic study and clinical results [corrected].
A free fascioadipocutaneous flap obtained from the medial thigh is suitable for breast reconstruction in Asian women with a small-to-moderate breast size. In this region, both a medial circumflex femoral artery perforator flap (MCFAp flap) and a posterior medial thigh perforator flap (PMTp flap) are options, based on perforators from the deep femoral vessels. Here, we evaluated the anatomic basis of the medial circumflex femoral artery (MCFA) perforators from the medial circumflex femoral vessels.



Between July 2010 and June 2014, 53 patients (55 flaps) underwent breast reconstruction using a fascioadipocutaneous flap from the medial thigh. MCFA perforators larger than or equal to 0.5 mm in this region were investigated. The following parameters were recorded intraoperatively: number of perforators, perforator locations, distance of the perforating point from the proximal thigh crease and anterior border of the gracilis muscle.



The total number of perforators was 131, with a mean of 2.4. The number of perforators coursing through the gracilis muscle (gracilis perforators) was the largest, followed by septocutaneous perforator coursing between the adductor longus and gracilis muscle. The average perforating point was located 6.5 cm below the proximal thigh crease and 2.2 cm from the anterior border of the gracilis muscle. Of the 102 procedures performed since 2006, 15 flaps were elevated as MCFAp flaps and there was no major complication.



In some cases, MCFA perforators are dominant in this region compared to PMT perforators. A perforator map can be helpful for identifying adequate MCFA perforators intraoperatively.
Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. maispe0719@yahoo.co.jp.
Mai
M
Shibuya
Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Toshihiko
T
Satake
Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Reiko
R
Nakasone
Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Marina
M
Ogawa
Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Mayu
M
Muto
Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Japan.
Kazutaka
K
Narui
Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Kazunori
K
Yasumura
Department of Breast Oncology, Tokyo Medical University Hospital, Tokyo, Japan.
Takashi
T
Ishikawa
Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.|Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan.
Jiro
J
Maegawa
D000328:Adult; D005260:Female; D005263:Femoral Artery / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061525:Perforator Flap; D011183:Postoperative Complications / Q000209:etiology; D060053:Transplant Donor Site
Autologous breast reconstruction; Gracilis muscle; Medial circumflex femoral artery; Perforator flap