The perforating arteries, usually three branches plus the end of the profunda femoris (often called the fourth), pierce adductor brevis and adductor magnus close to the linea aspera to reach the back of the thigh. They supply the hamstrings, adductors and the femoral shaft, and link up with each other in a chain of anastomoses. The first joins the cruciate anastomosis around the hip and the last anastomoses with muscular branches of the popliteal artery.
| Origin | Deep femoral artery (profunda femoris), usually three or four perforating branches |
|---|---|
| Course | Pierce adductor brevis and adductor magnus near the linea aspera to reach the posterior compartment, then wind laterally around the femur and pierce the lateral intermuscular septum to reach vastus lateralis; the nutrient artery of the femur usually arises from the second perforating artery |
| Branches |
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The perforating arteries cross the lateral intermuscular septum at several levels, so in the lateral approach to the femoral shaft each one must be ligated or coagulated to prevent a postoperative thigh haematoma. Excessive periosteal stripping during plating can damage their periosteal and nutrient supply to the bone. In proximal femoral tumour resection the profunda and its perforators may be sacrificed. The perforators are the pedicles of the profunda artery perforator (PAP) flap from the upper posterior thigh, an alternative to the DIEP flap in breast reconstruction.
Perforators crossing the lateral intermuscular septum are torn or cut during the lateral approach to the femur and can cause a large thigh haematoma unless each is controlled.
Disruption of the perforators and nutrient artery by fracture or extensive periosteal stripping reduces bone blood flow and can contribute to delayed union.
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