الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Anterior thigh skin continued over the years to provide advantageous donor sites for reconstructing defects all over the body. Reconstructive surgery has undergone unceasing alterations and modifications with the sole purpose of securing the best aesthetic and functional outputs. Of these alterations, a landmark shift was brought about by the concept of axiality which stated that flaps should be categorized according to their vasculature. from there on, more attention was directed to understanding the precise arterial supply of the skin.
However, the ability to obtain minimal thickness flaps with good survival rate and without the troublesome extensive dissection of the source vessel intramuscularly continued to pose a challenge to surgeons. This was resolved by the breakthrough concept of perforator-based flaps. The direct access to the flap pedicle was no longer required and instead, the approach starts most distally then continuing in a retrograde manner until the required flap thickness is achieved. This facilitated the retrieval of thin flaps constituting the superficial tissues: skin and fascia, based on the terminal cutaneous perforators.
This new paradigm in reconstructive surgery switched the impetus of vascular knowledge from the source artery to the perforator itself which, in turn, warranted the need of more illustrative anatomical vascular studies to define and describe perforators all over the human body.
The present work primarily aimed at studying the cutaneous perforators of the anterior thigh and explains their significance in flap design.
The material of the present study included thirty cadaveric lower limbs. The external iliac artery was injected with colored latex which travelled through the femoral tree to reach the most distal perforators. Superficial then deep dissections were undertaken under a magnifying lens to locate the perforators and identify their type according to Cormack’s and Lamberty’s tripartite system: direct, fasciocutaneous and musculocutaneous perforators. The length and diameter were measured and the courses of the perforators from their parent vessels to the skin were described.
As for the location, the anterior thigh skin was divided to three columns and each was then sectioned to upper, middle and lower squares. The locations of the perforators were assigned to one of these nine squares. The exact sites were then determined according to four bony landmarks: pubic tubercle, anterior superior iliac spine, medial and lateral tibial condyles.
This study showed that the mean number of perforators in the whole anterior thigh skin was 33.43±4.34. The largest number of perforators was located in squares 2 and 8 followed by squares 5 and 7 while the lowest number of perforators was found in square 6. The anteromedial skin (Squares 1-6) was supplied by 20.36 ± 3.5 perforators, while the anterolateral (Squares 7-9) by 13.9 ± 1.47. The superficial femoral artery surpassed the others in the number of perforators it provided, while the popliteal supplied the least.
The most abundant type of the three was type 2. Type 1 and 2 perforators were generally longer and wider than type 3. The largest caliber was the type 1 perforator; deep external pudendal perforator present in square 1, while the longest was a fasciocutaneous perforator between sartorius and upper vastus medialis spanning squares 2 and 5.
Squares 1 and 4 correspond to the medial and lateral halves of the skin over the femoral triangle respectively. The prevailing type in these two squares is direct cutaneous perforators from the CFA. The direct cutaneous perforators in square 1 were the superficial and deep external pudendal arteries in all cases, yet those in square 4 was the superficial circumflex iliac artery in all cases and another lower direct perforator in 66.6%. The SCIA spanned the upper middle and lateral squares. The lower contribution was from two fasciocutaneous perforators from the SFA at the apex of the triangle; one medial present in square 1 and reaching square 2 below, and another lateral present in square 4 and reaching square 5 below. They both were present in all cases.
Square 7 is lateral to the femoral triangle and comprises the skin of the TFL. It is primarily based on the LCFA except for the minor contribution of SCIA which extended from square 4. The three branches of the LCFA contributed to this area with the transverse branch owning the largest contribution. The ascending branch (AB) of the LCFA gave a fasciocutaneous perforator just below the ASIS in 20%. The transverse branch (TB) of the LCFA divided to three muscular arteries to the TFL upon entry of the muscle; upper, middle and lower, and they provided a musculocutaneous perforator in 100%, 60 % and 40 %, respectively. The descending branch (DB) of the LCFA gave a fasciocutaneous perforator