Biceps Femoris Musculocutaneous Flap for Reconstruction of Refractory Ulceration at the Popliteal Fossa

Several reports have addressed reconstruction of soft-tissue defects around the knee using a vascular pedicle island flap. Most of these flaps are transferred from the posterior aspect of the lower leg,1–7 and others are transferred from the anterior thigh area and are supplied by perforators from the popliteal artery.8–13 It is difficult, however, to cover a significant defect of the popliteal fossa area with a vascularized flap. We are aware of few previous studies investigating the possibility of elevating a flap from the posterior thigh region to cover popliteal soft-tissue defects. We report a rare case of refractory ulceration at the popliteal fossa caused by radiation therapy for a malignant tumor. The ulceration was successfully treated with a long head of the biceps femoris (LHBF) musculocutaneous flap. We hypothesized that a musculocutaneous flap could be elevated and transferred as a propeller flap to cover the popliteal soft-tissue defect when nutrient branches to the LHBF are present and branch at the distal aspect of the LHBF muscle. We describe the use of a novel propeller flap with perforators nourishing the LHBF muscle and the results of our preliminary anatomical study. Previous studies have revealed that the principal origin of the nutrient artery to the LHBF muscle is the deep femoral artery (DFA).14,15 Thus, we investigated the location, number, and courses of the branches from the DFA to the muscle. The distance to the distal border of the popliteal fossa, to which the propeller flap had to reach, was also investigated.