BACKGROUND: The authors present the posteromedial thigh flap as an alternative source for head and neck reconstruction, and the perforator patterns and vascular anatomy of this flap were further investigated. METHODS: From March to August of 2014, 23 patients underwent head and neck reconstruction with 23 posteromedial thigh flaps. The numbers, locations, and types of perforators were measured. The surgical technique and the results after reconstruction were evaluated. RESULTS: Most perforators

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... were located 8 to 10 cm away from the pubic crease on the reference line between the perineum and the insertion of the semitendinosus muscle. The average number of perforators was 1.7 (range, 1 to 3), and the average pedicle length was 10.3 cm (range, 8 to 13 cm). Eighty percent of the perforators (32 of 40) were musculocutaneous, and 20 percent (8 of 40) were septocutaneous. Ninety-five percent of the perforators (38 of 40) originated from the profunda femoris artery, and 5 percent (two of 40) originated from the medial circumflex femoral artery. The flap survival rate was 95.6 percent; one flap failed due to pedicle thrombosis. The donor sites were all closed primarily. CONCLUSIONS: The location of the perforators of the posteromedial thigh flap is consistent, and the pedicle length is sufficient to reach the neck region. Different reconstruction demands can be met by incorporating various softtissue components. The donor-site scar is well concealed, with minimal morbidity. The above advantages make the posteromedial thigh flap an excellent option for head and neck reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.