USE OF THE DESCENDING BRANCH OF LATERAL CIRCUMFLEX FEMORAL ARTERY AS A RECIPIENT PEDICLE FOR COVERAGE OF A KNEE DEFECT WITH FREE FLAP: ANATOMICAL AND CLINICAL STUDY

Background: With recent advances in free tissue transfer, soft tissue defects involving the knee can be covered perfectly utilizing various free flaps. Yet the success of this operation depends on a secure nontraumatic recipient pedicle around the knee area. The purpose of this study is to introduce the descending branch (DB) of the lateral circumflex femoral artery (LCFA) as a new recipient pedicle for knee defect coverage. Methods: Through autopsies of eight cadavers and a total of 11 extremities involving the area 10- and 15-cm above the upper margin of the patella, the number and sizes of the artery and vein of the descending branch of the lateral circumflex femoral artery were investigated. In a clinical setting, two cases of soft tissue defects in the area of the knee were reconstructed utilizing the DB of the LCFA with an anterolateral thigh perforator (ALTP) free flap on the ipsilateral side. Results: Anatomical: The descending branches of the lateral circumflex femoral vessels measuring 10- and 15-cm above the lateral aspect of the patella numbered 1 artery and about 1.5 veins. The diameters of these vessels ranged from 1.0 to 2.0 mm (1.4 +/- 0.4 mm) for the artery at 10-cm site and 1.0 to 3.0 mm (1.9 +/- 0.5 mm) at the 15-cm site and 0.8 to 2.0 mm (1.2 +/- 0.4 mm) for the vein at the 10-cm site and 1.0 to 3.0 mm (1.9 +/- 0.5 mm) at the 15-cm site. Under clinical conditions, the two case flaps survived well without major complications. The clinical follow-up period was from 12 to 14 months (mean: 13 months). Conclusions: The advantage in using this recipient pedicle lies not only in its superficial aspect but also in the protection offered by the surrounding muscle. Thus the defect could be reconstructed efficiently without stress upon the surgeon; if the ALTP flap of the ipsilateral side was used, the defect could be reconstructed efficiently within the same surgical field. (C) 2009 Wiley-Liss, Inc. Microsurgery 30:32-36, 2010.