The perforating arteries pierce the adductor magnus to supply the posterior thigh. The first perforating artery is the largest and most clinically important, providing the nutrient artery to the femoral shaft and the primary supply to the proximal hamstring muscles. The fourth perforating artery anastomoses with the descending genicular and popliteal vessels at the knee.
| Origin | Deep femoral artery (profunda femoris) — usually three or four perforating branches |
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Proximal femoral fractures can disrupt the first perforating artery, reducing femoral shaft vascularity. Perforating artery branches are divided during anterior approaches to the femoral shaft, requiring haemostatic control. The perforating artery system forms the basis of the profunda femoris artery perforator (PAP) flap used in breast reconstruction as an alternative to DIEP.
First perforating artery disruption in proximal femoral fractures reducing femoral shaft vascularity — a consideration in delayed fracture healing.
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