Detailed vascular anatomy of the medial femoral condyle and the significance of its use as a free flap

Abstract

The aim of this study is to provide detailed information on the arterial variations of the descending geniculate artery (DGA) for the harvest of a cortico-periostal flap from the medial femoral condyle and a fascio-cutaneous perforator flap with its respective pedicles. A total of 50 lower limbs from embalmed cadavers were dissected. The distribution pattern, length, and diameter of the DGA, saphenous artery (SA), muscular, periostal, and articular branches, and their concomitant veins were measured and evaluated. The DGA was present in 98% of the cases. In 80%, a Y-shaped distribution was identified where the SA branched from the DGA. Here, the mean lengths of DGA, SA, and the articular branch of the DGA were 3.2±1.1, 7.18±3.2, and 6.72±2.07cm, respectively. In 18%, an H-shaped distribution was noted, where the SA emerged directly from the femoral artery with a length of 10.2±1.9cm, whereas the length of the DGA (and its terminal articular branch) was 7.5±1.5cm. The mean length of the arterial pedicle for a cortico-periostal flap from the medial condyle was 9.92cm, whereas for the fascio-cutaneous perforator flap, it was 9.46cm in Y-shaped distribution and 10.2cm for the H-shaped distribution. Different arterial distribution patterns increase the need for routine preoperative vascular imaging when planning to harvest a cortico-periostal flap and a fascio-cutaneous perforator flap from the medial femoral condyle, especially when a double-chimeric flap is targeted. Level 4, case series.