Reconstruction of defects with the posterior femoral fasciocutaneous flap after resection of malignant tumours of the femoral greater trochanter, sacrococcygeal region and knee

Summary Objective To determine the vascular anatomy and clinical application of superiorly and inferiorly based posterior thigh fasciocutaneous flaps. Methods Ten consecutive patients were included in the study. All underwent resection of malignant tumours, five malignant fibrous histiocytomas (MFH), two synovial sarcomas, one skin squamous cell cancer, one malignant hamartoma and one fibrosarcoma. The average age of the patients was 49 years (range 25 to 71 years), with six men and four women. Superior defects, including two in the sacrococcygeal region and one lesion over the femoral greater trochanter, were closed with superior posterior femoral fasciocutaneous flaps (SPFFCF). Seven lesions, three in the popliteal fossae, and two in the lateral and two medial knee regions, were closed with inferior posterior femoral fasciocutaneous flaps (IPFFCF). The average flap size was 148 cm2 (ranging from 90 to 300 cm2 ). The average follow-up period was 23 months (ranging from 3 to 50 months). Patients were assessed by examination of the vascular anatomy, the operation technique and the treatment outcome. In particular the fasciocutaneous network and the descending branch of the inferior gluteal artery of the nutrient flap were analysed. Results There were no total skin flap failures and no significant complications. Tumours recurred locally in two patients and lung metastases occurred in another two. Five patients returned to their original jobs and daily activity without limitation, but two experienced decreased knee flexion of 30°. The larger SPFFCF is based on the fasciocutaneous branch of the inferior gluteal artery accompanied by the posterior gluteal cutaneous nerve. Conclusion The larger SPFFCF, which includes the fascia lata femoris and the fasciocutaneous branch with the posterior femoral cutaneous nerve, does not include the first cutaneous branch of the fasciocutaneous branch artery. Hence, large defects of the sacrococcygeal region and the femoral greater trochanter can be reconstructed using an SPFFCF. Defects around the knee can be reconstructed with an IPFFCF, which is based on the ascending branch of the fasciocutaneous branch of the 3rd perforating artery.