An analysis of the medial femoral condyle flap anatomy and the involvement of different tissue components for the reconstruction of complex defects.

Abstract

Aims: The reconstruction of complex defects involving various tissues still presents a challenge for reconstructive surgery and makes a combined flap indispensable. The mediodistal femur region (MDFR), which is supplied by the descending genicular artery (DGA), represents a unique donor site for harvesting combined flaps. This study analyzes the vascular anatomy of this region and the possible types of combined flaps.

Methods: Within this analysis, the vascular supply of the DGA in a total of 35 lower limbs was investigated, having been embalmed with the Walter Thiel technique in order to enable lifelike conditions.

Results: The DGA was detectable in 100% (n = 35) of all instances. The artery divided into three branches in 48.57% (n = 17) of cases and two branches in the remaining cases. In 40% (n = 14) of cases we found a saphenous artery (SA) and a musculoarticular branch (MAB), in 8.57% (n = 3) an articular branch (AB) and a muscular branch (MB), and in 2.86% (n = 1) a SA and a MB. Usage of DGA branches enabled corticoperiosteal, corticocancellous, osteochondral, or osteocutaneous flaps in 100% (n = 35) of our cases, and myocorticoperiostal, osteomyotendinous, osteomyotendocutanous, or osteotendofasciocutaneous flaps in 97.14% (n = 34). Vascular supply of skin flaps was feasible via the SA in 100% (n = 35) of cases or via dermal branches of the AB in 37.14% (n = 13).

Conclusion: The multitissue, distal-mediofemoral region, supplied by the DGA and its branches, offers an optimal donor site with reliable vascularization, enabling the harvesting of combined flaps.